Healthcare Provider Details

I. General information

NPI: 1205199940
Provider Name (Legal Business Name): STACY ANN URANDAY MFTI, RAS-I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 09/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4451 CALIFORNIA AVE APT 31
BAKERSFIELD CA
93309-1171
US

IV. Provider business mailing address

730 21ST STREET
BAKERSFIELD CA
93301
US

V. Phone/Fax

Practice location:
  • Phone: 661-709-9455
  • Fax:
Mailing address:
  • Phone: 661-709-9455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: