Provider Demographics
NPI:1316312499
Name:STANLEY, ERIKA BREANNE
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:BREANNE
Last Name:STANLEY
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 1:271 E BOGGY DEPOT RD
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-5135
Mailing Address - Country:US
Mailing Address - Phone:580-380-2799
Mailing Address - Fax:
Practice Address - Street 1:271 E BOGGY DEPOT RD
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-5135
Practice Address - Country:US
Practice Address - Phone:580-380-2799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health