Provider Demographics
NPI:1922596295
Name:RIDLEY, STACIE LORINDA (LPC)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:LORINDA
Last Name:RIDLEY
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 1:11740 S 129TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-1901
Mailing Address - Country:US
Mailing Address - Phone:918-268-8864
Mailing Address - Fax:
Practice Address - Street 1:11740 S 129TH EAST AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74011-1901
Practice Address - Country:US
Practice Address - Phone:918-268-8864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2023-07-26
Deactivation Date:2023-02-06
Deactivation Code:
Reactivation Date:2023-07-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health