Healthcare Provider Details

I. General information

NPI: 1285559906
Provider Name (Legal Business Name): MEGAN STACEY LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 N NORTHSIGHT BLVD STE 129
SCOTTSDALE AZ
85260-3675
US

IV. Provider business mailing address

6425 E PARADISE LN
SCOTTSDALE AZ
85254-1422
US

V. Phone/Fax

Practice location:
  • Phone: 480-997-0001
  • Fax:
Mailing address:
  • Phone: 480-826-9182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-23937
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: