Provider Demographics
NPI:1871877886
Name:STOCKTON, LEANN NICHOLE
Entity type:Individual
Prefix:
First Name:LEANN
Middle Name:NICHOLE
Last Name:STOCKTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEANN
Other - Middle Name:NICHOLE
Other - Last Name:STOCKTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, BHRS
Mailing Address - Street 1:512 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:TISHOMINGO
Mailing Address - State:OK
Mailing Address - Zip Code:73460-3214
Mailing Address - Country:US
Mailing Address - Phone:580-371-3672
Mailing Address - Fax:
Practice Address - Street 1:721 S GEORGE NIGH EXPY
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-7400
Practice Address - Country:US
Practice Address - Phone:918-302-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100746580AMedicaid