STACY LEA WALLACE (NPI# 1003249848) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003249848 |
| Entity Type | Individual |
| Full Name | STACY LEA WALLACE |
| Other Name | STACY WALLACE MARTIN |
| Credential | NCC |
| Practice Address |
540 Illinois St Pawnee OK 74058-2036 |
| Practice Telephone | 9187621045 |
| Mailing Telephone | 9187621045 |
| Enumeration Date | 2013-08-15 |
| Last Update Date | 2013-08-15 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386264109 | Stacy Wallace | Driver | 324 Kenilworth Ave, Toledo, OH 43610-1456 | 2020-04-22 |
| 1588131866 | Stacy Ann Wallace | Naturopath | 3976 East Harbor Road, Langley, WA 98260 | 2018-10-25 |
| 1487896668 | Stacy L Wallace | Dietitian, Registered | 20330 Huebner Rd, Suite 104, San Antonio, TX 78258-3508 | 2009-04-02 |
| 1952876641 | Stacy Rose Wallace | Chore Provider | 6725 S Eastern Ave, Las Vegas, NV 89119-3948 | 2018-10-09 |
| 1205843422 | Stacy Wallace | Nurse Practitioner | 1702 N Alamo St, Suite 220, San Antonio, TX 78215-1201 | 2006-08-01 |
| Street Address |
540 ILLINOIS ST |
| City | PAWNEE |
| State | OK |
| Zip Code | 74058-2036 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821275744 | Patsy Ann Cooper | Counselor | 540 Illinois St, Pawnee, OK 74058-2036 | 2008-01-22 |
| 1184232241 | Kerri Jacobs | Peer Specialist | 540 Illinois St, Pawnee, OK 74058-2036 | 2020-07-15 |
| 1043855372 | Melissa Coleman | Case Manager/Care Coordinator | 540 Illinois St, Pawnee, OK 74058-2036 | 2019-11-11 |
| 1669016341 | Jo Lynn Strate | Social Worker | 540 Illinois St, Pawnee, OK 74058-2036 | 2019-11-05 |
| 1912561903 | Jerri Lynn Shaw | Peer Specialist | 540 Illinois St, Pawnee, OK 74058-2036 | 2019-04-25 |
| 1851808042 | Talena Gay Odell | Counselor | 540 Illinois St, Pawnee, OK 74058-2036 | 2018-01-09 |
| 1669989943 | Deanna Lynn Whitten | Case Manager/Care Coordinator | 540 Illinois St, Pawnee, OK 74058-2036 | 2018-01-08 |
| 1346767761 | Belinda Stubblefield | Counselor | 540 Illinois St, Pawnee, OK 74058-2036 | 2017-08-25 |
| 1821518614 | Bailey Reann Huckeby | Case Manager/Care Coordinator | 540 Illinois St, Pawnee, OK 74058-2036 | 2017-06-22 |
| 1447665187 | Laura Afton Edens | Registered Nurse | 540 Illinois St, Pawnee, OK 74058-2036 | 2014-06-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316214430 | Tonya L Houston | Nurse Practitioner | Pawnee Indian Health Center, 1201 Heritage Cir, Pawnee, OK 74058 | 2011-11-17 |
| 1659662153 | Christie Factor | Counselor | 540 Illinois, Pawnee, OK 74058 | 2011-05-02 |
| 1366476368 | Henry J Kaehler Jr Dds PC | Clinic/Center | 401 Forest St, Pawnee, OK 74058 | 2006-07-10 |
| 1003892621 | Brady Gene Englestead | Pediatrics | 1201 Heritage Circle, Pawnee, OK 74058 | 2005-12-15 |
| 1598039620 | Cah Acquisition Company 12 LLC | Clinic/Center | 535 6th St, Pawnee, OK 74058 | 2012-03-07 |
| 1659473080 | Henry John Kaehler Jr. | Dentist | 401 Forest St, Pawnee, OK 74058 | 2006-09-05 |
| 1578503611 | William Lester Carruth | Dentist | 481 Agency Road, Pawnee, OK 74058-0130 | 2006-06-07 |
| 1225158314 | Cockrell Eyecare Center | Optometrist | 534 Illinois St, Pawnee, OK 74058-2036 | 2007-03-30 |
| 1427192541 | Boss Medical, LLC | Durable Medical Equipment & Medical Supplies | 524 Illinois St, Pawnee, OK 74058-2036 | 2007-02-20 |
| 1659456978 | City of Pawnee | Ambulance | 510 Illinois St, Pawnee, OK 74058-2036 | 2006-10-26 |
| Find all providers in zip 74058 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659662153 | Christie Factor | Counselor | 540 Illinois, Pawnee, OK 74058 | 2011-05-02 |
| 1851808042 | Talena Gay Odell | Counselor | 540 Illinois St, Pawnee, OK 74058-2036 | 2018-01-09 |
| 1346767761 | Belinda Stubblefield | Counselor | 540 Illinois St, Pawnee, OK 74058-2036 | 2017-08-25 |
| 1669817508 | Jillian Dawes | Counselor | 540 Illinois St, Pawnee, OK 74058-2036 | 2013-05-06 |
| 1447506993 | Camron Shekarforoosh | Counselor | 540 Illinois St, Pawnee, OK 74058-2036 | 2012-08-01 |
| 1841565124 | Michelle Cecilia Basile | Counselor | 540 Illinois St, Pawnee, OK 74058-2036 | 2012-03-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164039517 | Tommy Craig Smith | Counselor | 3601 N Classen Blvd Ste 102, Oklahoma City, OK 73118-3231 | 2020-09-29 |
| 1881200558 | Nichole Rae Krausch | Counselor | 1507 S Mckenna St, Poteau, OK 74953-5207 | 2020-09-18 |
| 1467068098 | Mckenzie Mcguffee | Counselor | 717 Briarcrest Dr, Midwest City, OK 73110-1619 | 2020-09-18 |
| 1629683727 | Mason Counseling Services | Counselor | 12718 E 77th Pl N, Owasso, OK 74055-7938 | 2020-09-15 |
| 1437761004 | Ashley Jane Runnells | Counselor | 4867 S Sheridan Rd Ste 712a, Tulsa, OK 74145-5721 | 2020-08-17 |
| 1982214292 | Tera Dee Robbins | Counselor | 1002 Cambell Street, Warner, OK 74469 | 2020-08-03 |
| 1619587946 | Chelsey S Kopaddy | Counselor | 1108 Nw Elm Ave, Lawton, OK 73507-4607 | 2020-08-02 |
| 1932718376 | David Louis Holden | Counselor | 1803 W Wood Drive, Okmulgee, OK 74447 | 2020-07-30 |
| 1043829278 | Tracy Nanette Mckeown | Counselor | 1777 S Yukon Pkwy, Yukon, OK 73099-4599 | 2020-07-23 |
| 1063039915 | Sarah Nicole Hawthorne | Counselor | 12834 S Old Highway 169, Oologah, OK 74053-3333 | 2020-06-26 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.