Provider Demographics
NPI:1154925394
Name:NALE-STADOM, STACY LEIGH (LMFT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LEIGH
Last Name:NALE-STADOM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 N ORLANDO AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5521
Mailing Address - Country:US
Mailing Address - Phone:407-790-4101
Mailing Address - Fax:407-277-4400
Practice Address - Street 1:253 N ORLANDO AVE STE 202
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5521
Practice Address - Country:US
Practice Address - Phone:407-790-4101
Practice Address - Fax:407-277-4400
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2624106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty