Provider Demographics
NPI:1053749598
Name:ESPINOZA, STACY R (LPC/CR)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:R
Last Name:ESPINOZA
Suffix:
Gender:F
Credentials:LPC/CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-1928
Mailing Address - Country:US
Mailing Address - Phone:937-280-2000
Mailing Address - Fax:
Practice Address - Street 1:300 W NATIONAL RD
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-1928
Practice Address - Country:US
Practice Address - Phone:937-280-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1200290101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional