Stacey Counseling Associates LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

STACEY COUNSELING ASSOCIATES LLC

Practice address

50740 Princess Way
Suite 700
Granger, IN 46530-4339

Phone

(269) 277-0025

Fax

(574) 271-0479

NPI assigned

Jun 30, 2011

Last updated

Jun 30, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Christine Frances Stacey, LCSW

Title

Owener

Phone

(269) 277-0025

Specialties & licenses 2

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1309392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309392000000",
    "number": "1952698706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50802 CHESTNUT RIDGE DR",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465308280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50740 PRINCESS WAY",
            "address_2": "SUITE 700",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465304339",
            "telephone_number": "269-277-0025",
            "fax_number": "574-271-0479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STACEY COUNSELING ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-30",
        "last_updated": "2011-06-30",
        "status": "A",
        "authorized_official_last_name": "STACEY",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_middle_name": "FRANCES",
        "authorized_official_title_or_position": "OWENER",
        "authorized_official_telephone_number": "269-277-0025",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ICAADC",
            "identifier": "602763",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.