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General NPI Number Information
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NPI Number | 1912690066
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Entity Type | Individual
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Provider Name | STACY BRUTON
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Gender | Female
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Dates
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Enumeration Date | 06/02/2023
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 480 CHADBOURNE RD
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City | FAIRFIELD
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State | CA
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Zip | 94534-9639
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Country | US
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Telephone | 510-317-1444
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Fax |
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Provider Business Mailing Address
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Address Line | 1625 E 8TH ST APT 32
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City | DAVIS
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State | CA
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Zip | 95616-2445
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Country | US
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Telephone | 515-339-2464
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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 | 119649
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License Number State | IA
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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 | 17899
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License Number State | CA
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