Provider Demographics
NPI:1215704218
Name:RUBIN-SHEPHERD, STACI REBECCA (LPC)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:REBECCA
Last Name:RUBIN-SHEPHERD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 E CLARK RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-2675
Mailing Address - Country:US
Mailing Address - Phone:480-272-1989
Mailing Address - Fax:
Practice Address - Street 1:10149 N 92ND ST STE 103
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4557
Practice Address - Country:US
Practice Address - Phone:480-666-7697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-21571101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional