STACEY A BLANK Professional Counselor License verification

Business Entity

INACTIVE

License Type

Professional Counselor

Description

LICENSED CLINICAL PROFESSIONAL COUNSELOR

License Number

180003378

License Status

INACTIVE

Business

First Name

STACEY A

Last Name

BLANK

Business Name

STACEY A BLANK

Original Issue Date

06/17/1999

Effective Date

02/24/2005

Expiration Date

03/31/2005

City

LOVELAND

State

Zip

80537

County

COLORADO

Ever Disciplined

LastModifiedDate

09/11/2005