Individual
STACI SHORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1769 BOULEVARD DE PROVINCE APT E, BATON ROUGE, LA 70816-8618
(225) 892-4444
Mailing address
1769 BOULEVARD DE PROVINCE APT E, BATON ROUGE, LA 70816-8618
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
MFT 1096
LA
101YP2500X
Professional Counselor
Primary
LPC3219
LA
101YP2500X
Professional Counselor
MFT 1096
LA
101YS0200X
School Counselor
MFT 1096
LA
106H00000X
Marriage & Family Therapist
MFT 1096
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47-2598992
—
LA
Enumeration date
12/22/2014
Last updated
11/30/2016
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