MEDICARE: STACEY HOTH MA, MS,LMHC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	122437	IA

General Provider Information

NPI Number	:	1477188860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY HOTH MA, MS,LMHC, NCC

Provider Business Mailing Address
First Line	:	2205 FALLS AVE STE 1
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50701-5705
Country	:	US
Telephone Number	:	319-209-5193
Fax Number	:	844-561-0881

Provider Business Practice Location Address
First Line	:	2205 FALLS AVE STE 1
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50701-5705
Country	:	US
Telephone Number	:	319-209-5193
Fax Number	:	844-561-0881

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2020
Last Update Date	:	04/10/2026

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