Provider Demographics
NPI:1316413818
Name:DAVIS, STACEY DAWN (LCPC)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:DAWN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 STATE LINE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-3212
Mailing Address - Country:US
Mailing Address - Phone:816-363-2600
Mailing Address - Fax:816-523-0068
Practice Address - Street 1:9001 STATE LINE RD STE 300
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-3212
Practice Address - Country:US
Practice Address - Phone:816-363-2600
Practice Address - Fax:816-523-0068
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03723101YP2500X
MO2001007479101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional