Provider Demographics
NPI:1245319649
Name:AHRONS, STACEY J (PHD)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:J
Last Name:AHRONS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6556 LONETREE BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-6008
Mailing Address - Country:US
Mailing Address - Phone:530-320-1490
Mailing Address - Fax:
Practice Address - Street 1:3160 FOLSOM BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5219
Practice Address - Country:US
Practice Address - Phone:916-733-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11964103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5717744OtherFIRST HEALTH
CA2277400OtherPACIFICARE
CAMCMG379200OtherWESTERN HEALTH ADVANTAGE
CAPSY11964OtherBLUE CROSS
CA1851337OtherGREAT WEST
CA257705OtherINTERPLAN
CA7504366OtherAETNA
CA000810823283OtherPHCS
CA5717744OtherFIRST HEALTH