Provider Demographics
NPI:1205040375
Name:HOUSE FIELDS, STACEY ANTOINETTE (BA CM D)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:ANTOINETTE
Last Name:HOUSE FIELDS
Suffix:
Gender:F
Credentials:BA CM D
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:ANTOINETTE
Other - Last Name:HOUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA CM D
Mailing Address - Street 1:650 S PEORIA
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-4429
Mailing Address - Country:US
Mailing Address - Phone:918-587-9471
Mailing Address - Fax:918-560-0137
Practice Address - Street 1:2325 S HARVARD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-3300
Practice Address - Country:US
Practice Address - Phone:918-712-4301
Practice Address - Fax:918-712-3409
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator