1285805762 NPI number — MRS. STACY D'LYNN EGGSWARE MC, LPC, LCMHC

Table of content: MRS. STACY D'LYNN EGGSWARE MC, LPC, LCMHC (NPI 1285805762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285805762 NPI number — MRS. STACY D'LYNN EGGSWARE MC, LPC, LCMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EGGSWARE
Provider First Name:
STACY
Provider Middle Name:
D'LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MC, LPC, LCMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BURNS
Provider Other First Name:
STACY
Provider Other Middle Name:
D'LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MC, LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285805762
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
655 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENNINGTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05201-2870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-494-4040
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
655 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENNINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05201-2870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-494-4040
Provider Business Practice Location Address Fax Number:
602-491-2119
Provider Enumeration Date:
03/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LPC-11745 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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