Individual
DR. MARDI STACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1718 W JEFFERSON ST, BOISE, ID 83702-3949
(208) 424-8130
(208) 424-8137
Mailing address
1718 W JEFFERSON ST, BOISE, ID 83702-3949
(208) 424-8130
(208) 424-8137
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY-429
ID
Other
Enumeration date
12/01/2006
Last updated
07/08/2007
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