Provider Demographics
NPI:1316299654
Name:SKILLMAN, STACIE LYN
Entity type:Individual
Prefix:MS
First Name:STACIE
Middle Name:LYN
Last Name:SKILLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 VIA DELLA GRECA
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-1701
Mailing Address - Country:US
Mailing Address - Phone:760-267-8948
Mailing Address - Fax:
Practice Address - Street 1:327 VIA DELLA GRECA
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-1701
Practice Address - Country:US
Practice Address - Phone:760-267-8948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171W00000XOther Service ProvidersContractor