Healthcare Provider Details

I. General information

NPI: 1679115927
Provider Name (Legal Business Name): STACEY SABISH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 11/02/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 N 6TH ST
SHEBOYGAN WI
53081-4113
US

IV. Provider business mailing address

805 N 6TH ST
SHEBOYGAN WI
53081-4113
US

V. Phone/Fax

Practice location:
  • Phone: 920-457-8866
  • Fax:
Mailing address:
  • Phone: 920-457-8866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4480-226
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8137-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: