Individual
CLAY R STACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW
Contact information
Practice address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4264
(417) 761-5000
(417) 761-5011
Mailing address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4264
(417) 761-5000
(417) 761-5011
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2017043729
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14480990
CAQH
MO
01
—
2020012248
STATE LICENSE
MO
05
—
490074582
—
MO
Enumeration date
06/07/2019
Last updated
12/07/2020
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