Provider Demographics
NPI:1063724524
Name:MAHAN, STORI LOUISE (BA)
Entity type:Individual
Prefix:
First Name:STORI
Middle Name:LOUISE
Last Name:MAHAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12721 SAINT ANDREWS TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8807
Mailing Address - Country:US
Mailing Address - Phone:405-514-9072
Mailing Address - Fax:
Practice Address - Street 1:12721 SAINT ANDREWS TER
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8807
Practice Address - Country:US
Practice Address - Phone:405-514-9072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor