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General NPI Number Information
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NPI Number | 1710855127
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Entity Type | Individual
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Provider Name | STACEY SILL
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Gender |
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Dates
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Enumeration Date | 10/27/2025
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 905 E WILSON ST
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City | SHAWNEE
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State | OK
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Zip | 74804-4165
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Country | US
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Telephone | 405-214-0116
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Fax |
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Provider Business Mailing Address
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Address Line | 17767 DEER TRL
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City | MCLOUD
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State | OK
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Zip | 74851-8650
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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