| Stacy Kraft, Lcsw, Llc | |
|
425 Fairview Ave Ste 1 Ponca City OK 74601-1924 | |
| (580) 382-5770 | |
| Not Available |
| Full Name | Stacy Kraft, Lcsw, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 425 Fairview Ave Ste 1, Ponca City, Oklahoma |
| Authorized Official Name and Position | Stacy Kraft (OWNER) |
| Authorized Official Contact | 5803825770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stacy Kraft, Lcsw, Llc 425 Fairview Ave Ste 1 Ponca City OK 74601-1924 Ph: (580) 382-5770 | Stacy Kraft, Lcsw, Llc 425 Fairview Ave Ste 1 Ponca City OK 74601-1924 Ph: (580) 382-5770 |
| NPI Number | 1932565645 |
|---|---|
| Provider Enumeration Date | 01/11/2016 |
| Last Update Date | 01/11/2016 |
| Medicare PECOS PAC ID | 9739481425 |
|---|---|
| Medicare Enrollment ID | O20160113000066 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932565645 | NPI | - | NPPES |
| 200323460A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Stacy L Kraft |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497846851 PECOS PAC ID: 5496754731 Enrollment ID: I20061213000541 |
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