Provider Demographics
NPI:1265930481
Name:KATZ, STACEY (LPCC)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:KATZ
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 ROANOKE DR APT 115
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-6135
Mailing Address - Country:US
Mailing Address - Phone:707-210-4832
Mailing Address - Fax:
Practice Address - Street 1:3120 TELEGRAPH AVE STE 3
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1964
Practice Address - Country:US
Practice Address - Phone:628-243-9884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA7221101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health