Individual
SUSAN MICHELLE STACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C-PRSS
Contact information
Practice address
105365 S HIGHWAY 102, MCLOUD, OK 74851-3051
(405) 988-2071
Mailing address
105365 S HIGHWAY 102, MCLOUD, OK 74851-3051
(405) 988-2071
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
175T00000X
Peer Specialist
13205
OK
175T00000X
Peer Specialist
Primary
132075
OK
Other
Enumeration date
06/08/2018
Last updated
11/07/2022
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