Provider Demographics
NPI:1295540888
Name:STRAIGHT, STACY BURTON (CSWA)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:BURTON
Last Name:STRAIGHT
Suffix:
Gender:
Credentials:CSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 FRONT ST NE STE 230
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-0860
Mailing Address - Country:US
Mailing Address - Phone:503-383-9253
Mailing Address - Fax:
Practice Address - Street 1:2405 FRONT ST NE STE 230
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-0860
Practice Address - Country:US
Practice Address - Phone:503-383-9253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health