Individual
STACIA PAUL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BHCMS
Contact information
Practice address
121 W. MAPLE, ENID, OK 73701
(580) 234-8865
(580) 234-8361
Mailing address
3537 CHICKADEE LANE, ENID, OK 73703
(580) 402-2788
(580) 234-8361
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
23084
OK
Other
Enumeration date
10/06/2011
Last updated
10/06/2011
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