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General NPI Number Information
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NPI Number | 1114286358
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Entity Type | Individual
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Provider Name | STACY NICOLE LUCE LCPC
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Gender | Female
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Dates
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Enumeration Date | 05/09/2012
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Last Update Date | 08/24/2020
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Provider Practice Location Address
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Address Line | 404 KOOTENAI ST
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City | KOOTENAI
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State | ID
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Zip | 83840-0276
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Country | US
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Telephone | 810-845-4472
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 203
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City | KOOTENAI
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State | ID
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Zip | 83840-0203
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Country | US
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Telephone | 810-845-4472
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCPC-6335
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCPC-6335
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License Number State | ID
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