Individual
STACEY J CLOSSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
2410 GRAPE RD STE 6, MISHAWAKA, IN 46545-3015
(574) 283-1234
(574) 537-2652
Mailing address
10100 ELIDA RD, DELPHOS, OH 45833-9058
(419) 695-8010
(606) 328-5153
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39000588A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39000588A
LICENSE
IN
Enumeration date
02/27/2006
Last updated
06/03/2024
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