Provider Demographics
NPI:1043599574
Name:KAMINSKI, STACEY MARIE HILTZ (LLPC)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:MARIE HILTZ
Last Name:KAMINSKI
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 S CANAL ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49651-8859
Mailing Address - Country:US
Mailing Address - Phone:231-342-8105
Mailing Address - Fax:
Practice Address - Street 1:305 S CANAL ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:MI
Practice Address - Zip Code:49651-8859
Practice Address - Country:US
Practice Address - Phone:231-342-8105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012071101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional