Provider Demographics
NPI:1871982892
Name:BRETHAUER, STACIE (MA, BSL, LPC)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:BRETHAUER
Suffix:
Gender:F
Credentials:MA, BSL, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:583 BRANDYWINE DR
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-5716
Mailing Address - Country:US
Mailing Address - Phone:724-612-8366
Mailing Address - Fax:
Practice Address - Street 1:583 BRANDYWINE DR
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-5716
Practice Address - Country:US
Practice Address - Phone:724-612-8366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health