Provider Demographics
NPI:1497573893
Name:LUIS, STACY ELAINE (CADC-R)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:ELAINE
Last Name:LUIS
Suffix:
Gender:F
Credentials:CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9570 SW BARBUR BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5412
Mailing Address - Country:US
Mailing Address - Phone:971-232-2234
Mailing Address - Fax:
Practice Address - Street 1:9570 SW BARBUR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-5412
Practice Address - Country:US
Practice Address - Phone:971-232-2234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-24-4363101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)