Individual ProviderKate Beverly StacyCounselorBehavioral Health & Social Service ProvidersPractice Address1601 E 4th Plain Blvd, Bldg 17 Ste B222, Vancouver, WA 98661-3713(360) 397-8484(360) 384-8484PECOS EnrollmentBased on the most recent information from CMS, provider Kate Beverly Stacy does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 10:04 AM.Profile DetailsProvider ID1225494867Provider TypeIndividualFull NameStacy, Kate BeverlyTitleMrs.GenderFemaleSole ProprietorNoEnumeration Date1/12/2016Last Updated1/12/2016Contact InformationPractice LocationPractice Address1601 E 4th Plain Blvd, Bldg 17 Ste B222, Vancouver, WA 98661-3713Phone(360) 397-8484Fax(360) 397-8494Mailing LocationMailing AddressPO Box 1845, Vancouver, WA 98668-1845Phone(360) 384-8484Fax(360) 397-8494Provider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode101YA0400XDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseCO60619612Washington