Basic Information
| Provider Information | |||||||||
| NPI: | 1821388158 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUICK | ||||||||
| FirstName: | STACY | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 W 3RD ST | ||||||||
| Address2: | |||||||||
| City: | GLADWIN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486241150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893023813 | ||||||||
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| Practice Location | |||||||||
| Address1: | 655 E CEDAR AVE | ||||||||
| Address2: | |||||||||
| City: | GLADWIN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486242215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894269295 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2011 | ||||||||
| LastUpdateDate: | 04/07/2011 | ||||||||
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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 | 101YP2500X | 6401012347 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.