Healthcare Provider Details

I. General information

NPI: 1497678262
Provider Name (Legal Business Name): ELLA STACEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 S PERRY ST
CASTLE ROCK CO
80104-1919
US

IV. Provider business mailing address

3878 HOURGLASS AVE
CASTLE ROCK CO
80109-3735
US

V. Phone/Fax

Practice location:
  • Phone: 719-309-2684
  • Fax:
Mailing address:
  • Phone: 443-632-7473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number26-542807
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: