MEDICARE: STACEY SCHINSKE LPC CANDIDATE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1811417249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY SCHINSKE LPC CANDIDATE

Provider Business Mailing Address
First Line	:	8612 SW 65TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73169-6966
Country	:	US
Telephone Number	:	405-473-3460
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 N BROADWAY ST STE 100
Second Line	:
City	:	MOORE
State	:	OK
Zip	:	73160-5135
Country	:	US
Telephone Number	:	405-990-0816
Fax Number	:	405-735-6116

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2017
Last Update Date	:	04/17/2019

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