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NPI Code Detail

MEDICARE: STACY BRUTON

MEDICARE: STACY BRUTON
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
1101YM0800XMental Health Counselor119649IA
2101YP2500XProfessional Counselor17899CA

General Provider Information

NPI Number : 1912690066
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY BRUTON
Provider Business Mailing Address
First Line : 1625 E 8TH ST APT 32
Second Line :
City : DAVIS
State : CA
Zip : 95616-2445
Country : US
Telephone Number : 515-339-2464
Fax Number :
Provider Business Practice Location Address
First Line : 480 CHADBOURNE RD
Second Line :
City : FAIRFIELD
State : CA
Zip : 94534-9639
Country : US
Telephone Number : 510-317-1444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2023
Last Update Date : 03/04/2026

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Directions to “ STACY BRUTON ” Practice Location

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