Provider Demographics
NPI:1386088284
Name:CHESTNUT-WATSON, STACEY (LPC)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:CHESTNUT-WATSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:CHESTNUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8341 NW MACE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64152-4618
Mailing Address - Country:US
Mailing Address - Phone:816-368-1371
Mailing Address - Fax:816-256-5594
Practice Address - Street 1:8341 NW MACE RD STE 120
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64152
Practice Address - Country:US
Practice Address - Phone:816-368-1371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013008441101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1437694841Medicaid