Healthcare Provider Details

I. General information

NPI: 1356450266
Provider Name (Legal Business Name): STACEY MARIE KREITZ LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STACEY MARIE GROTEMEYER MFT INTERN

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 E MAIN ST STE 303
LITITZ PA
17543-1941
US

IV. Provider business mailing address

79 E MAIN ST STE 303
LITITZ PA
17543-1941
US

V. Phone/Fax

Practice location:
  • Phone: 805-295-0458
  • Fax:
Mailing address:
  • Phone: 805-295-0458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF001336
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number49183
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: