Provider Demographics
NPI:1316807670
Name:DODGE, STEPHANIE ANN (MS, LPC U/S)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:DODGE
Suffix:
Gender:F
Credentials:MS, LPC U/S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18720 LAZY GROVE DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-0037
Mailing Address - Country:US
Mailing Address - Phone:405-249-8359
Mailing Address - Fax:
Practice Address - Street 1:6051 N BROOKLINE AVE STE 112
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4286
Practice Address - Country:US
Practice Address - Phone:405-810-0054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-17
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLPCCANDIDATE13099101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor