Provider Demographics
NPI:1710166350
Name:BRACE, STEPHANIE LYNN (MHR, LPC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:BRACE
Suffix:
Gender:F
Credentials:MHR, LPC
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:LYNN
Other - Last Name:STACKENWALT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ALLEMAN
Mailing Address - Street 1:PO BOX 748465
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8465
Mailing Address - Country:US
Mailing Address - Phone:855-284-7483
Mailing Address - Fax:
Practice Address - Street 1:8520 W KELLY SUE DR
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-1560
Practice Address - Country:US
Practice Address - Phone:405-612-4773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLPC03284101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3284OtherCOUNSELOR-MENTAL HEALTH