Provider Demographics
NPI:1538601828
Name:URAUCHI, STACEY
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:URAUCHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 AVILA ST
Mailing Address - Street 2:STE 102
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-4287
Mailing Address - Country:US
Mailing Address - Phone:213-229-0985
Mailing Address - Fax:213-229-0986
Practice Address - Street 1:900 AVILA ST
Practice Address - Street 2:STE 102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-4287
Practice Address - Country:US
Practice Address - Phone:213-229-0985
Practice Address - Fax:213-229-0986
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1235281016101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)