Provider Demographics
NPI:1427312412
Name:WEST, STACY M (BS)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:M
Last Name:WEST
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4645 KUEBLER RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47720-7648
Mailing Address - Country:US
Mailing Address - Phone:812-319-9174
Mailing Address - Fax:812-429-9655
Practice Address - Street 1:2700 W INDIANA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-5637
Practice Address - Country:US
Practice Address - Phone:812-428-0698
Practice Address - Fax:812-429-9655
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor