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STACY NICOLE LUCE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCPC

Contact information

Practice address
404 KOOTENAI ST, KOOTENAI, ID 83840-0276
(810) 845-4472
Mailing address
PO BOX 203, KOOTENAI, ID 83840-0203
(810) 845-4472

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LCPC-6335
ID
101YP2500X
Professional Counselor
Primary
LCPC-6335
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1114286358
ID
Enumeration date
05/09/2012
Last updated
08/24/2020
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