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MS. STACEY L PROTHRO LCSW

Mental Health >> Counselor >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1437323003

Individual Registrant:
MS. STACEY L PROTHRO LCSW
Gender: F
Sole Proprietor

Location and contact information for practice:
4101 MCGOWEN ST STE 110133  LONG BEACH, CA 90808-1898 US
Tel: 310-962-7126  Fax: --

Contact information for business:
4101 MCGOWEN ST STE 110-133  LONG BEACH, CA 90808-1898 US
Tel: 310-962-1726  Fax: --

Registration Information:
NPI: 1437323003
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N101YM0800XBehavioral Health & Social Service Providers
Counselor
Mental Health
N1041S0200XBehavioral Health & Social Service Providers
Social Worker
Y1041C0700XBehavioral Health & Social Service Providers
Social Worker
CA29497

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




HEALTH CARE JOBS CA - Page 1



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