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General NPI Number Information
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NPI Number | 1215704218
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Entity Type | Individual
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Provider Name | STACI REBECCA RUBIN-SHEPHERD LPC
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Gender | Female
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Dates
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Enumeration Date | 12/08/2023
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 10149 N 92ND ST STE 103
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4557
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Country | US
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Telephone | 480-666-7697
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Fax |
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Provider Business Mailing Address
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Address Line | 3313 E CLARK RD
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City | PHOENIX
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State | AZ
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Zip | 85050-2675
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Country | US
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Telephone | 480-272-1989
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-21571
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License Number State | AZ
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