Provider Demographics
NPI:1518070267
Name:JONES, STACY RENEE (BSW)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:RENEE
Last Name:JONES
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 S BEARD ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-8311
Mailing Address - Country:US
Mailing Address - Phone:405-258-3040
Mailing Address - Fax:405-240-5008
Practice Address - Street 1:112 NORTH MCKINLEY
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834
Practice Address - Country:US
Practice Address - Phone:405-258-3040
Practice Address - Fax:405-240-5008
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health