Provider Demographics
NPI:1215248901
Name:STEPHENS, ANITA KIM
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:KIM
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 532
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:OK
Mailing Address - Zip Code:74563-0532
Mailing Address - Country:US
Mailing Address - Phone:918-906-1303
Mailing Address - Fax:
Practice Address - Street 1:2552 NE 1161ST AVE
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:OK
Practice Address - Zip Code:74563-2463
Practice Address - Country:US
Practice Address - Phone:918-906-1303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor