Organization
STACY KRAFT, LCSW, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACY KRAFT LCSW (OWNER)
(580) 382-5770
Entity
Organization
Contact information
Practice address
425 FAIRVIEW AVE STE 1, PONCA CITY, OK 74601-1924
(580) 382-5770
Mailing address
425 FAIRVIEW AVE STE 1, PONCA CITY, OK 74601-1924
(580) 382-5770
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200323460A
—
OK
Enumeration date
01/11/2016
Last updated
01/11/2016
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