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General NPI Number Information
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NPI Number | 1871892638
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Entity Type | Organization
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Legal Business Name | STACEY MARSH LLC
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Dates
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Enumeration Date | 03/19/2011
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Last Update Date | 03/19/2011
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Provider Practice Location Address
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Address Line | 6805 RIVERGATE LN
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City | OKLAHOMA CITY
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State | OK
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Zip | 73132-3904
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Country | US
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Telephone | 405-401-9428
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Fax |
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Provider Business Mailing Address
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Address Line | 6805 RIVERGATE LN
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City | OKLAHOMA CITY
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State | OK
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Zip | 73132-3904
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Country | US
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Telephone | 405-401-9428
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. STACEY L. MARSH
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Credential | MED, LPC
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Telephone | 405-401-9428
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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 | 3342
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License Number State | OK
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