Provider Demographics
NPI:1205176088
Name:DOUGLAS, STEPHANIE LYNNE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNNE
Last Name:DOUGLAS
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 1:1307 N MERIDIAN AVE
Mailing Address - Street 2:# 363
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-5132
Mailing Address - Country:US
Mailing Address - Phone:405-596-6007
Mailing Address - Fax:
Practice Address - Street 1:1307 N MERIDIAN AVE
Practice Address - Street 2:# 363
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-5132
Practice Address - Country:US
Practice Address - Phone:405-596-6007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor