Susan Michelle Stacy, C-PRSS

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

132075 Issued in OK

Practice address

105365 S Highway 102
McLoud, OK 74851-3051

Phone

(405) 988-2071

NPI assigned

Jun 8, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667779200000",
    "number": "1124511639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105365 S HIGHWAY 102",
            "city": "MCLOUD",
            "state": "OK",
            "postal_code": "748513051",
            "telephone_number": "405-988-2071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105365 S HIGHWAY 102",
            "city": "MCLOUD",
            "state": "OK",
            "postal_code": "748513051",
            "telephone_number": "405-988-2071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACY",
        "first_name": "SUSAN",
        "middle_name": "MICHELLE",
        "credential": "C-PRSS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-08",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OK",
            "license": "13205",
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OK",
            "license": "132075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeri K. Singleton, M.D.
• Carol E Siniard, P.A.
• Tim K Smalley, M.D.
• Gabriela Maria Smith, LCSW
• Jordan Squyres, LMFT-C
• Amanda Jean Standlee, DOULA
• Steadfast Medical Group PLLC
• Carla Renee Sumano
• Daley Tearl, LMFT, LADC
• Patricia Naomi Tehauno, AS

• All providers in McLoud, OK
• Peer Specialist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.