Provider Demographics
NPI:1174877203
Name:MCFANN, STACY L (LPCC-S)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:MCFANN
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:L
Other - Last Name:MCFANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:178 PRIVATE ROAD 19423
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680-8831
Mailing Address - Country:US
Mailing Address - Phone:740-451-0741
Mailing Address - Fax:740-313-0426
Practice Address - Street 1:178 PRIVATE ROAD 19423
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680-8831
Practice Address - Country:US
Practice Address - Phone:740-451-0741
Practice Address - Fax:740-313-0426
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1000490101YM0800X
OHE.1000490-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0176548Medicaid