Organization
STACY J NIELSEN, LCSW, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACY JEAN NIELSEN LCSW (OWNER)
(541) 802-6597
Entity
Organization
Contact information
Practice address
11 SW BRANTLEY DR, WINSTON, OR 97496-4526
(541) 679-0366
Mailing address
11 SW BRANTLEY DR, WINSTON, OR 97496
(541) 679-0366
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
L6376
OR
Other
Enumeration date
06/27/2016
Last updated
06/27/2016
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