Healthcare Provider Details

I. General information

NPI: 1497362826
Provider Name (Legal Business Name): STACEY STAFFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 W 124TH AVE STE 200
WESTMINSTER CO
80234-1882
US

IV. Provider business mailing address

1511 W 124TH AVE STE 200
WESTMINSTER CO
80234-1882
US

V. Phone/Fax

Practice location:
  • Phone: 720-648-8285
  • Fax:
Mailing address:
  • Phone: 720-648-8285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC.0017848
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: