Active NPI
Ashley Elizabeth Stacy, BS, BHRS
- Rehabilitation Psychologist
- Tishomingo, OK
National Provider Identifier
1891037412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Psychologist
- Practice address
- 801 E Main St
Tishomingo, OK 73460-2351 - Phone
- (580) 371-3776
- Fax
- (580) 371-2056
- NPI assigned
- Mar 21, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Psychologist | 103TR0400X | Primary |
Addresses
Primary practice location
801 E Main St
Tishomingo, OK 73460-2351
Mailing address
19385 Gardenhire Rd
Howe, OK 74940-7003
Phone (918) 635-5613
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200226970A | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor of Science
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pennington Creek Life House | Past | Accepting new patients | |
| Pennington Creek Lifehouse | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Tishomingo, OK
- NPI 1164771366
-
- Community/Behavioral Health Agency
- Tishomingo, OK
- NPI 1831464304
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1363824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1373500800000",
"number": "1891037412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19385 GARDENHIRE RD",
"city": "HOWE",
"state": "OK",
"postal_code": "749407003",
"telephone_number": "918-635-5613"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 E MAIN ST",
"city": "TISHOMINGO",
"state": "OK",
"postal_code": "734602351",
"telephone_number": "580-371-3776",
"fax_number": "580-371-2056"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STACY",
"first_name": "ASHLEY",
"middle_name": "ELIZABETH",
"name_prefix": "Mrs.",
"credential": "BS, BHRS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-03-21",
"last_updated": "2013-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TR0400X",
"taxonomy_group": "",
"desc": "Psychologist, Rehabilitation",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200226970A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tishomingo, OK
- Southeastern Oklahoma Family Services, Inc
- Southern Oklahoma Treatment Services, Inc
- Southern Oklahoma Treatment Services, Inc.
- Southern Oklahoma Treatment Services, Inc.
- Southern Oklahoma Treatment Services, Inc.
- Tommie Gay Stanberry, PA-C
- Jennifer Nicole Standridge
- Cody Don Stephens
- Kalyn Michelle Stephens, LPC
- Ashley Nicole Stites, APRN, CNP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.