Provider Demographics
NPI:1073609228
Name:ALSABROOK, STACIA JEANICE (MS, LPC, CIMHP)
Entity Type:Individual
Prefix:MS
First Name:STACIA
Middle Name:JEANICE
Last Name:ALSABROOK
Suffix:
Gender:F
Credentials:MS, LPC, CIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10563 E 142ND ST N
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021-3761
Mailing Address - Country:US
Mailing Address - Phone:918-237-1506
Mailing Address - Fax:918-553-1131
Practice Address - Street 1:10563 E 142ND ST N
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:OK
Practice Address - Zip Code:74021-3761
Practice Address - Country:US
Practice Address - Phone:918-237-1506
Practice Address - Fax:918-553-1131
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3996101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health