Provider Demographics
NPI:1073958211
Name:STEPHENS, CODY DON
Entity Type:Individual
Prefix:MR
First Name:CODY
Middle Name:DON
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N FISHER ST APT 9
Mailing Address - Street 2:
Mailing Address - City:TISHOMINGO
Mailing Address - State:OK
Mailing Address - Zip Code:73460-1318
Mailing Address - Country:US
Mailing Address - Phone:580-920-5745
Mailing Address - Fax:
Practice Address - Street 1:501 N FISHER ST APT 9
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460-1318
Practice Address - Country:US
Practice Address - Phone:580-920-5745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor