Provider Demographics
NPI:1962267492
Name:HOLDMAN, STACY L
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:HOLDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 STARLING CT
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-1077
Mailing Address - Country:US
Mailing Address - Phone:918-955-0514
Mailing Address - Fax:
Practice Address - Street 1:4660 STARLING CT
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-7406
Practice Address - Country:US
Practice Address - Phone:918-955-0514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health