Individual
STACY ANN BERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
550 S PEORIA AVE, TULSA, OK 74120-3820
(918) 588-1900
(918) 582-6405
Mailing address
550 S PEORIA AVE, TULSA, OK 74120-3820
(918) 588-1900
(918) 582-6405
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
3570
OK
174H00000X
Health Educator
Primary
21410447
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200566570 A
—
OK
Enumeration date
10/25/2006
Last updated
09/21/2015
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