Individual
MRS. STACEY NICOLLE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16725 LITTLE LEAF LN, EDMOND, OK 73012-0675
(405) 409-2878
Mailing address
825 NW 16TH ST, OKLAHOMA CITY, OK 73106-6401
(405) 409-2878
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
05/14/2013
Last updated
05/14/2013
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