Provider Demographics
NPI:1194410563
Name:STACIA A. BUCHANAN, MSBS, LPC-S
Entity type:Organization
Organization Name:STACIA A. BUCHANAN, MSBS, LPC-S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:STACIA
Authorized Official - Middle Name:ADELE
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSBS, LPC
Authorized Official - Phone:580-730-0084
Mailing Address - Street 1:1503 W GORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-3608
Mailing Address - Country:US
Mailing Address - Phone:580-730-0232
Mailing Address - Fax:833-279-4266
Practice Address - Street 1:249 LAKE CREST DR
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-9330
Practice Address - Country:US
Practice Address - Phone:580-730-0084
Practice Address - Fax:833-279-4266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty