Healthcare Provider Details

I. General information

NPI: 1831535723
Provider Name (Legal Business Name): STACEY TASLER CROSSON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 467 BOX 3504
APO AE
09096-0036
US

IV. Provider business mailing address

KELLERSKOPFSTR. 15A
TAUNUSSTEIN HESSEN
65232
DE

V. Phone/Fax

Practice location:
  • Phone: 015122649476
  • Fax:
Mailing address:
  • Phone: 015122649476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0001054
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: