Healthcare Provider Details

I. General information

NPI: 1316085574
Provider Name (Legal Business Name): STACY JO ROMERO LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACY JO ROMERO LPCC

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2528 RIDGE RUNNER RD
LAS VEGAS NM
87701-4971
US

IV. Provider business mailing address

2528 RIDGE RUNNER RD
LAS VEGAS NM
87701-4971
US

V. Phone/Fax

Practice location:
  • Phone: 505-425-2622
  • Fax:
Mailing address:
  • Phone: 505-617-5777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0122611
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: