Provider Demographics
NPI:1679771968
Name:DEAN, STACEY NICOLE (LPC)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:NICOLE
Last Name:DEAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 COPPER COVE DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3009
Mailing Address - Country:US
Mailing Address - Phone:405-590-0900
Mailing Address - Fax:
Practice Address - Street 1:1505 COPPER COVE DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3009
Practice Address - Country:US
Practice Address - Phone:405-590-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
OK3147101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional