Healthcare Provider Details

I. General information

NPI: 1871887026
Provider Name (Legal Business Name): STACY JEAN HOLBROOK M.S., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 E LAKE MEAD PKWY STE 105
HENDERSON NV
89015-6443
US

IV. Provider business mailing address

98 E LAKE MEAD PKWY STE 105
HENDERSON NV
89015-6443
US

V. Phone/Fax

Practice location:
  • Phone: 702-823-4300
  • Fax: 702-906-1844
Mailing address:
  • Phone: 702-823-4300
  • Fax: 702-906-1844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: