MEDICARE: ALEICIA L STAFFORD LPC RPT PLLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1053822536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEICIA L STAFFORD LPC RPT PLLC

Provider Business Mailing Address
First Line	:	5509 MAIN ST STE 102
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-5511
Country	:	US
Telephone Number	:	405-706-2190
Fax Number	:

Provider Business Practice Location Address
First Line	:	5509 MAIN ST STE 102
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-5511
Country	:	US
Telephone Number	:	405-706-2190
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALEICIA L STAFFORD
Credential	:	LPC
Telephone Number	:	405-706-2190

Provider Enumeration Date	:	10/23/2017
Last Update Date	:	05/06/2024

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