Provider Demographics
NPI:1134943467
Name:KRIDER, STACY ELIZABETH (LPC, NCC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:ELIZABETH
Last Name:KRIDER
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 CANDLELIGHT CT
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-2501
Mailing Address - Country:US
Mailing Address - Phone:504-453-1480
Mailing Address - Fax:
Practice Address - Street 1:933 CANDLELIGHT CT
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-2501
Practice Address - Country:US
Practice Address - Phone:504-453-1480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6527101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health