Healthcare Provider Details

I. General information

NPI: 1437063898
Provider Name (Legal Business Name): STACEE LYNN ST. CLAIR LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N BROADWAY
PERU IN
46970-1070
US

IV. Provider business mailing address

7329 N PAW PAW PIKE
DENVER IN
46926-9251
US

V. Phone/Fax

Practice location:
  • Phone: 574-722-5151
  • Fax: 574-739-1414
Mailing address:
  • Phone: 574-835-5481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39006230A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: