Provider Demographics
NPI:1366164568
Name:MORNINGWAKE, STACEY (PHD)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:MORNINGWAKE
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 1:1217 REINHARDT DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-4217
Mailing Address - Country:US
Mailing Address - Phone:719-460-2275
Mailing Address - Fax:
Practice Address - Street 1:5360 N ACADEMY BLVD STE 130
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4096
Practice Address - Country:US
Practice Address - Phone:719-227-7477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health