Provider Demographics
NPI:1558007682
Name:WOOD, STACY RAE (LPC, CRC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:RAE
Last Name:WOOD
Suffix:
Gender:F
Credentials:LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W RICHARDS ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-8931
Mailing Address - Country:US
Mailing Address - Phone:307-358-9771
Mailing Address - Fax:
Practice Address - Street 1:801 W RICHARDS ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:WY
Practice Address - Zip Code:82633-8931
Practice Address - Country:US
Practice Address - Phone:307-358-9771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1878101YM0800X
WY61341101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYLPC-1878OtherMENTAL HEALTH PROFESSIONS LICENSING BOARD
WY61341OtherPROFESSIONAL TEACHING STANDARDS BOARD SCHOOL COUNSELING LICENSE