Provider Demographics
NPI:1699210591
Name:RAMIREZ, STACEY (APCC)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29662 EDGEMERE WAY
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-6451
Mailing Address - Country:US
Mailing Address - Phone:909-659-6055
Mailing Address - Fax:
Practice Address - Street 1:2505 E LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4446
Practice Address - Country:US
Practice Address - Phone:951-471-1426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-30
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA160133412101YS0200X
CA18142101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool