Provider Demographics
NPI:1275320780
Name:CARTER, STACEY LAUREN (MS, NCC, LMHC)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:LAUREN
Last Name:CARTER
Suffix:
Gender:
Credentials:MS, NCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28208 STATE ROUTE 1 STE 101
Mailing Address - Street 2:
Mailing Address - City:WEST HARRISON
Mailing Address - State:IN
Mailing Address - Zip Code:47060-9410
Mailing Address - Country:US
Mailing Address - Phone:812-576-1600
Mailing Address - Fax:
Practice Address - Street 1:28208 STATE ROUTE 1
Practice Address - Street 2:
Practice Address - City:WEST HARRISON
Practice Address - State:IN
Practice Address - Zip Code:47060-9686
Practice Address - Country:US
Practice Address - Phone:812-576-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39005421A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health