Organization
STACY WRIGHT
Active
Other names
Faithful Counsel
Organization subpart
No
Provider details
NPI number
Authorized official
STACY L WRIGHT PSYD, HSPP (PSYCHOLOGIST)
(219) 714-7147
Entity
Organization
Contact information
Practice address
5505 S COUNTY ROAD 475 E, SELMA, IN 47383-9678
(219) 714-7147
(219) 627-1887
Mailing address
5505 S COUNTY ROAD 475 E, SELMA, IN 47383-9678
(219) 714-7147
(219) 627-1887
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
20041886A
IN
1041C0700X
Clinical Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000834190
ANTHEM BLUE CROSS BLUE SHIELD
IN
05
—
200813850A
—
IN
01
—
669102
BEACON HEALTH OPTIONS
IN
Enumeration date
10/30/2017
Last updated
08/09/2022
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