Doctor Name: | MRS. STACEY RENEE DRY |
NPI Number: | 1295054567 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 235026 |
Business Practice Address: | 32890 S 321st West Ave Bristow, OK - 740104215 |
Business Phone Number: | 9183676485 |
Business Fax Number: | |
Mailing Address: | 32890 S 321st West Ave, BRISTOW |
State: | OK |
Postal Code: | 740104215 |
Phone Number: | 9183676485 |
Fax Number: | |
NPI Enumeration Date: | 05/25/2010 |
NPI Last Update Date: | 05/25/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YS0200X |
License Number: | 235026 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | School |
Taxonomy Definition: |