Provider Demographics
NPI:1972804847
Name:CHRISTIAN, STEPHANIE LATRESE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LATRESE
Last Name:CHRISTIAN
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 1:1437 JOHN RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-3649
Mailing Address - Country:US
Mailing Address - Phone:405-653-5895
Mailing Address - Fax:580-223-7856
Practice Address - Street 1:830 PARK ST SE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-8364
Practice Address - Country:US
Practice Address - Phone:405-653-5895
Practice Address - Fax:580-223-7856
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OK11460101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health