Individual
MS. STACEY RENE LE FEVRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
100 NAVARRE PL, STE 5570, SOUTH BEND, IN 46601-1169
(574) 647-8610
Mailing address
3245 HEALTH DRIVE, SUITE 100, GRANGER, IN 46530-3245
(574) 647-1840
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20043223A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300021361
—
IN
Enumeration date
06/29/2010
Last updated
09/21/2023
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