Provider Demographics
NPI:1053738724
Name:VATTER, STACEY (LPC, CAADC)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:
Last Name:VATTER
Suffix:
Gender:F
Credentials:LPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 W BIG BEAVER RD STE 475
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4903
Mailing Address - Country:US
Mailing Address - Phone:248-230-2511
Mailing Address - Fax:
Practice Address - Street 1:755 W BIG BEAVER RD STE 475
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4903
Practice Address - Country:US
Practice Address - Phone:248-230-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-19
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382230613OtherFIN