Provider Demographics
NPI:1053730622
Name:STACEY GUSS LCSW LLC
Entity type:Organization
Organization Name:STACEY GUSS LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:EVE
Authorized Official - Last Name:GUSS
Authorized Official - Suffix:I
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-779-2390
Mailing Address - Street 1:14 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7332
Mailing Address - Country:US
Mailing Address - Phone:541-779-2390
Mailing Address - Fax:541-779-3260
Practice Address - Street 1:14 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7332
Practice Address - Country:US
Practice Address - Phone:541-779-2390
Practice Address - Fax:541-779-3260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty