MEDICARE: ALEICIA L STAFFORD

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	172V00000X	Community Health Worker
2	101YP2500X	Professional Counselor	5832	OK
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1255672812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEICIA L STAFFORD

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	:
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2013
Last Update Date	:	05/06/2024

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Directions to “ ALEICIA L STAFFORD ” Practice Location

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