Provider Demographics
NPI:1629324959
Name:LEE, STACY (PHD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S JOHNSTONE AVE
Mailing Address - Street 2:SUITE 503
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-6622
Mailing Address - Country:US
Mailing Address - Phone:918-337-6050
Mailing Address - Fax:918-337-6061
Practice Address - Street 1:501 S JOHNSTONE AVE
Practice Address - Street 2:SUITE 503
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-6622
Practice Address - Country:US
Practice Address - Phone:918-337-6050
Practice Address - Fax:918-337-6061
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool