Provider Demographics
NPI:1427093707
Name:WAITES, STACEY M (LCSW)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:M
Last Name:WAITES
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:MCGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 513
Mailing Address - Street 2:
Mailing Address - City:TREGO
Mailing Address - State:MT
Mailing Address - Zip Code:59934-0513
Mailing Address - Country:US
Mailing Address - Phone:601-831-1965
Mailing Address - Fax:
Practice Address - Street 1:465 EDNA CREEK
Practice Address - Street 2:
Practice Address - City:TREGO
Practice Address - State:MT
Practice Address - Zip Code:39201-2503
Practice Address - Country:US
Practice Address - Phone:601-831-1965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC20161041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical