Provider Demographics
NPI:1124468525
Name:STEWART, TERESA GAIL DOSS
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:GAIL DOSS
Last Name:STEWART
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 1:8959 N 133RD EAST AVE
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4754
Mailing Address - Country:US
Mailing Address - Phone:918-625-8655
Mailing Address - Fax:
Practice Address - Street 1:8959 N 133RD EAST AVE
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4754
Practice Address - Country:US
Practice Address - Phone:918-625-8655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCERTIFICATE ONLY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health