Provider Demographics
NPI:1427193820
Name:BUCHANAN, STACIA A (MSBS, LPC-S)
Entity Type:Individual
Prefix:MRS
First Name:STACIA
Middle Name:A
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:MSBS, LPC-S
Other - Prefix:
Other - First Name:STACIA
Other - Middle Name:A
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSBS, LPC
Mailing Address - Street 1:1503 W GORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-3608
Mailing Address - Country:US
Mailing Address - Phone:580-730-0232
Mailing Address - Fax:833-279-4266
Practice Address - Street 1:1503 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3608
Practice Address - Country:US
Practice Address - Phone:580-730-0232
Practice Address - Fax:833-279-4266
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200949300Medicaid
OK200440680AMedicaid