Healthcare Provider Details

I. General information

NPI: 1174748586
Provider Name (Legal Business Name): STACY S MERRYWEATHER PCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 ROCKY LN
ASHLAND OH
44805-4701
US

IV. Provider business mailing address

2233 ROCKY LN
ASHLAND OH
44805-4701
US

V. Phone/Fax

Practice location:
  • Phone: 419-281-3716
  • Fax: 419-281-4605
Mailing address:
  • Phone: 419-281-3716
  • Fax: 419-281-4605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0002881
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: