Provider Demographics
NPI:1619768470
Name:AUSTIN, STACY RENEE (NBHWC)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:RENEE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:NBHWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6272 S KELLERMAN CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-6170
Mailing Address - Country:US
Mailing Address - Phone:720-662-6072
Mailing Address - Fax:
Practice Address - Street 1:6272 S KELLERMAN CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-6170
Practice Address - Country:US
Practice Address - Phone:720-662-6072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO976711171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach