Individual
STACEY ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2530 S COMMERCE ST, ARDMORE, OK 73401-5519
(580) 223-2537
(580) 223-2487
Mailing address
2530 S COMMERCE ST, ARDMORE, OK 73401-5519
(580) 223-2537
(580) 223-2487
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
10/16/2013
Last updated
10/16/2013
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