Basic Information
| Provider Information | |||||||||
| NPI: | 1245319649 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AHRONS | ||||||||
| FirstName: | STACEY | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6556 LONETREE BLVD STE 104 | ||||||||
| Address2: | |||||||||
| City: | ROCKLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957656008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303201490 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3160 FOLSOM BLVD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958165219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167333333 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2006 | ||||||||
| LastUpdateDate: | 12/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PSY11964 | CA | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 5717744 | 01 | CA | FIRST HEALTH | OTHER | 2277400 | 01 | CA | PACIFICARE | OTHER | MCMG379200 | 01 | CA | WESTERN HEALTH ADVANTAGE | OTHER | PSY11964 | 01 | CA | BLUE CROSS | OTHER | 1851337 | 01 | CA | GREAT WEST | OTHER | 257705 | 01 | CA | INTERPLAN | OTHER | 7504366 | 01 | CA | AETNA | OTHER | 000810823283 | 01 | CA | PHCS | OTHER |