Individual
MRS. CASEY ELIZABETH STACKHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 N UNION AVE, SHAWNEE, OK 74801-7067
(405) 275-7100
Mailing address
47725 CEMETERY RD, MAUD, OK 74854-4811
(405) 374-2845
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/28/2016
Last updated
09/28/2016
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