Provider Demographics
NPI:1386928455
Name:DEVELOPMENTAL & THERAPEUTIC SERVICES, PLLC
Entity type:Organization
Organization Name:DEVELOPMENTAL & THERAPEUTIC SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:918-622-4841
Mailing Address - Street 1:2326 S GARNETT RD
Mailing Address - Street 2:STE G
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-5121
Mailing Address - Country:US
Mailing Address - Phone:918-622-4841
Mailing Address - Fax:918-622-4898
Practice Address - Street 1:2326 S GARNETT RD
Practice Address - Street 2:STE G
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-5121
Practice Address - Country:US
Practice Address - Phone:918-622-4841
Practice Address - Fax:918-622-4898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4651101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty