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General NPI Number Information
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NPI Number | 1326096967
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Entity Type | Individual
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Provider Name | STACEY GROVES LMFT
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Gender | Female
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 03/11/2014
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Provider Practice Location Address
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Address Line | 7 E HENDRICKS ST
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City | SHELBYVILLE
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State | IN
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Zip | 46176-2124
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Country | US
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Telephone | 317-392-2564
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Fax | 317-392-9545
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Provider Business Mailing Address
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Address Line | 6626 E 75TH STREET SUITE 500
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2890
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Country | US
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Telephone | 317-621-7561
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Fax | 317-355-6096
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 87000981A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 35001558
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License Number State | IN
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