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NPI Code Detail

MEDICARE: STACY VERNICK

MEDICARE: STACY VERNICK
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 CounselorCA

General Provider Information

NPI Number : 1578766390
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY VERNICK
Provider Business Mailing Address
First Line : 625 CANTRILL DRIVE
Second Line : APT 435
City : DAVIS
State : CA
Zip : 95618-7751
Country : US
Telephone Number : 530-902-5229
Fax Number :
Provider Business Practice Location Address
First Line : 584 KENTUCKY AVENUE
Second Line :
City : WOODLAND
State : CA
Zip : 95695-2779
Country : US
Telephone Number : 530-661-3213
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2007
Last Update Date : 07/08/2007

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Directions to “ STACY VERNICK ” Practice Location

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