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MS. STACEY L PROTHRO LCSW
Mental Health >> Counselor >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1437323003
Individual Registrant:MS. STACEY L PROTHRO LCSW
Gender: F
Sole Proprietor
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: --
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: --
Tel: 310-962-1726 Fax: --
Registration Information:
NPI: 1437323003
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 101YM0800X | Behavioral Health & Social Service Providers Counselor Mental Health | ||
| N | 1041S0200X | Behavioral Health & Social Service Providers Social Worker | ||
| Y | 1041C0700X | Behavioral Health & Social Service Providers Social Worker | CA | 29497 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
