Individual
STACYE ELIZABETH MCQUEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
104 E MAIN ST STE 200, INEZ, KY 41224-8928
(606) 298-7633
Mailing address
PO BOX 158, PAINTSVILLE, KY 41240-0158
(606) 792-1381
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
252812
KY
103TC0700X
Clinical Psychologist
139343
KY
Other
Enumeration date
11/07/2019
Last updated
11/07/2019
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