Stacer, Shaneen Diane
Stacer, Shaneen Diane is an individual health care provider with primary practice located at 1900 Woodland Dr , Coos Bay OR 97420-2045. She recently has 8 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Cognitive & Behavioral, Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Clinical Child & Adolescent, Behavioral Health & Social Service Providers / Health, Behavioral Health & Social Service Providers / Health Service, Behavioral Health & Social Service Providers / Group Psychotherapy. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Stacer, Shaneen Diane can be contacted via phone (541) 267-5151.Contact Information
Primary practice address
1900 Woodland Dr
Coos Bay OR 97420-2045
Phone: (541) 267-5151
Fax: (541) 266-4554
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Psychologist | 103T00000X | 3079-57 | Wisconsin |
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 103TA0400X | 3079-57 | Wisconsin |
| Behavioral Health & Social Service Providers / Cognitive & Behavioral | 103TB0200X | 3079-57 | Wisconsin |
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 3079-57 | Wisconsin |
| Behavioral Health & Social Service Providers / Clinical Child & Adolescent | 103TC2200X | 3079-57 | Wisconsin |
| Behavioral Health & Social Service Providers / Health | 103TH0004X | 3079-57 | Wisconsin |
| Behavioral Health & Social Service Providers / Health Service | 103TH0100X | 3079-57 | Wisconsin |
| Behavioral Health & Social Service Providers / Group Psychotherapy | 103TP2701X | 3079-57 | Wisconsin |
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 2500 | Oregon |
Profile Details
| NPI number | 1427485440 |
|---|---|
| LBN Legal business name | Stacer, Shaneen Diane |
| Credentials | PHD |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 4th, 2013 |
| Last updated | Sep 8th, 2016 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1427485440 | NPPES |
| Oregon | Other | 161133 | NORTH BEND MEDICAL CENTER GROUP MEDICAID |
| Oregon | Other | R0000WFBTV | NORTH BEND MEDICAL CENTER GROUP MEDICAID |
| Oregon | MEDICAID | 500684206 | NORTH BEND MEDICAL CENTER GROUP MEDICAID |
| Oregon | Other | 1407812365 | NORTH BEND MEDICAL CENTER GROUP MEDICAID |
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