Provider Demographics
NPI:1134446321
Name:THOMAS, STACEY
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:THOMAS
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 1:2600 NW 63RD ST
Mailing Address - Street 2:APT. 83
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-4950
Mailing Address - Country:US
Mailing Address - Phone:405-312-5178
Mailing Address - Fax:
Practice Address - Street 1:2600 NW 63RD ST
Practice Address - Street 2:APT 83
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-4950
Practice Address - Country:US
Practice Address - Phone:405-312-5178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health