Healthcare Provider Details

I. General information

NPI: 1447021357
Provider Name (Legal Business Name): STACEY L BYERS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 09/07/2024
Certification Date: 09/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5932 W MEADOWBROOK AVE
PHOENIX AZ
85033-2122
US

IV. Provider business mailing address

6635 W HAPPY VALLEY RD STE A104-621
GLENDALE AZ
85310-2609
US

V. Phone/Fax

Practice location:
  • Phone: 623-231-4987
  • Fax: 888-927-0409
Mailing address:
  • Phone: 602-358-7073
  • Fax: 888-927-0409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-22478
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: