Individual
STACEY M WAITES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
465 EDNA CREEK, TREGO, MT 39201-2503
(601) 831-1965
Mailing address
PO BOX 513, TREGO, MT 59934-0513
(601) 831-1965
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C2016
MS
Other
Enumeration date
06/19/2006
Last updated
03/20/2025
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