Provider Demographics
NPI:1376728477
Name:TADOKORO, STACEY ELAINE (LSCSW)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:ELAINE
Last Name:TADOKORO
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:ELAINE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSCSW
Mailing Address - Street 1:1715 E CEDAR ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1891
Mailing Address - Country:US
Mailing Address - Phone:816-977-3178
Mailing Address - Fax:816-623-5612
Practice Address - Street 1:1715 E CEDAR ST
Practice Address - Street 2:SUITE 115
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1891
Practice Address - Country:US
Practice Address - Phone:816-977-3178
Practice Address - Fax:816-623-5612
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3935101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health