Provider Demographics
NPI:1003493636
Name:STANTON, MAKAYLA MAE (LCSW)
Entity Type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:MAE
Last Name:STANTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 FREEDOM LN
Mailing Address - Street 2:
Mailing Address - City:ELDON
Mailing Address - State:MO
Mailing Address - Zip Code:65026-5255
Mailing Address - Country:US
Mailing Address - Phone:573-692-5923
Mailing Address - Fax:
Practice Address - Street 1:130 CALO LN
Practice Address - Street 2:
Practice Address - City:LAKE OZARK
Practice Address - State:MO
Practice Address - Zip Code:65049-9208
Practice Address - Country:US
Practice Address - Phone:573-746-7371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-28
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210038581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical