Provider Demographics
NPI:1821438706
Name:HOWARD, STACEY A (LCSW)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:A
Last Name:HOWARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:A
Other - Last Name:BAILEY-JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:9751 N GOVERNMENT WAY STE 4
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-9645
Mailing Address - Country:US
Mailing Address - Phone:208-518-1096
Mailing Address - Fax:208-601-6181
Practice Address - Street 1:9751 N GOVERNMENT WAY STE 4
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-9645
Practice Address - Country:US
Practice Address - Phone:208-682-0572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-31630104100000X
IDLCSW-440721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker