Provider Demographics
NPI:1821972308
Name:EATMON, STACY
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:EATMON
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 1:10293 BLOOMFIELD ST
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2264
Mailing Address - Country:US
Mailing Address - Phone:562-799-4700
Mailing Address - Fax:
Practice Address - Street 1:10293 BLOOMFIELD ST
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2264
Practice Address - Country:US
Practice Address - Phone:562-799-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25650101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health