Provider Demographics
NPI:1699382101
Name:LOKUTA, STACEY EVELYN
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:EVELYN
Last Name:LOKUTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 RUSSELL CT APT 10
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-2163
Mailing Address - Country:US
Mailing Address - Phone:570-407-0762
Mailing Address - Fax:
Practice Address - Street 1:120 BURRUS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BRODHEADSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18322-7812
Practice Address - Country:US
Practice Address - Phone:570-407-0762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012046101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional