Provider Demographics
NPI:1811227143
Name:ROGERS, STACEY SIMONSON (MHR)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:SIMONSON
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MHR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11015 S 85TH EAST AVE
Mailing Address - Street 2:A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7308
Mailing Address - Country:US
Mailing Address - Phone:918-639-7460
Mailing Address - Fax:
Practice Address - Street 1:5656 S 129TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74134-6715
Practice Address - Country:US
Practice Address - Phone:918-357-7003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor