Provider Demographics
NPI:1699056689
Name:CROOKS, STACIE L (TBS)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:L
Last Name:CROOKS
Suffix:
Gender:F
Credentials:TBS
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:L
Other - Last Name:STEGALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:968 MARLENE ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5995
Mailing Address - Country:US
Mailing Address - Phone:707-489-9500
Mailing Address - Fax:
Practice Address - Street 1:350 E GOBBI ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5511
Practice Address - Country:US
Practice Address - Phone:707-472-2922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor