Provider Demographics
NPI:1114377934
Name:MCCALL, STACEY LEE
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:LEE
Last Name:MCCALL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:LEE
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8323 E 117TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-1903
Mailing Address - Country:US
Mailing Address - Phone:405-326-5297
Mailing Address - Fax:
Practice Address - Street 1:12710 E STATE FARM BLVD S
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146
Practice Address - Country:US
Practice Address - Phone:918-986-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator