Provider Demographics
NPI:1699947804
Name:MAPLES, STACEY L (PHD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:L
Last Name:MAPLES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:STACEY
Other - Middle Name:L
Other - Last Name:WILLIS-CENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1407 S ELLIOTT AVE STE B
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:MO
Mailing Address - Zip Code:65605-2103
Mailing Address - Country:US
Mailing Address - Phone:417-440-0826
Mailing Address - Fax:888-602-7956
Practice Address - Street 1:1407 S ELLIOTT AVE STE B
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MO
Practice Address - Zip Code:65605-2103
Practice Address - Country:US
Practice Address - Phone:417-440-0826
Practice Address - Fax:888-602-7956
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008007986103TC0700X
FLPY6345103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical