Individual
MISS STACEY RENEE BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3105 E SKELLY DR, TULSA, OK 74105-6358
(918) 712-0859
(918) 388-6456
Mailing address
3105 E SKELLY DR, TULSA, OK 74105-6358
(918) 712-0859
(918) 388-6456
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3675
OK
Other
Enumeration date
02/13/2007
Last updated
04/26/2010
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