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NPI Code Detail

MEDICARE: STACY L MCFANN LPCC-S

MEDICARE: STACY L MCFANN LPCC-S
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorC1000490OH
2101YP2500XProfessional CounselorE.1000490-SUPVOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174877203
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY L MCFANN LPCC-S
Provider Business Mailing Address
First Line : 178 PRIVATE ROAD 19423
Second Line :
City : SOUTH POINT
State : OH
Zip : 45680-8831
Country : US
Telephone Number : 740-451-0741
Fax Number : 740-313-0426
Provider Business Practice Location Address
First Line : 178 PRIVATE ROAD 19423
Second Line :
City : SOUTH POINT
State : OH
Zip : 45680-8831
Country : US
Telephone Number : 740-451-0741
Fax Number : 740-313-0426
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2012
Last Update Date : 03/20/2018

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Directions to “ STACY L MCFANN LPCC-S” Practice Location

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