Provider Demographics
NPI:1053822536
Name:ALEICIA L STAFFORD LPC RPT PLLC
Entity Type:Organization
Organization Name:ALEICIA L STAFFORD LPC RPT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-227-3227
Mailing Address - Street 1:3509 N GLENOAKS DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-1303
Mailing Address - Country:US
Mailing Address - Phone:405-227-3227
Mailing Address - Fax:
Practice Address - Street 1:1212 S AIR DEPOT BLVD STE 19B
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4830
Practice Address - Country:US
Practice Address - Phone:405-706-2190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health