Healthcare Provider Details

I. General information

NPI: 1447776364
Provider Name (Legal Business Name): STACY ELIZABETH LOUTHAN-MATHYS LPC, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 10/11/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COURTHOUSE CIRCLE
DANBURY NC
27016
US

IV. Provider business mailing address

PO BOX 153
DANBURY NC
27016-0153
US

V. Phone/Fax

Practice location:
  • Phone: 336-650-6170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: