Provider Demographics
NPI:1174933642
Name:HART, STACY (MA LPC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 271395
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127
Mailing Address - Country:US
Mailing Address - Phone:720-520-2519
Mailing Address - Fax:
Practice Address - Street 1:8420 S CONTINENTAL DIVIDE RD #223
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127
Practice Address - Country:US
Practice Address - Phone:720-520-2519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
COLPC.0013849101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No172V00000XOther Service ProvidersCommunity Health Worker