Provider Demographics
NPI:1093072704
Name:STEPHENS, TALESHA ANN (BSW)
Entity Type:Individual
Prefix:MRS
First Name:TALESHA
Middle Name:ANN
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:TALESHA
Other - Middle Name:ANN
Other - Last Name:COPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:650 S PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-4429
Mailing Address - Country:US
Mailing Address - Phone:918-587-9471
Mailing Address - Fax:918-560-1399
Practice Address - Street 1:3511 MEADOWBROOK DR
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-7928
Practice Address - Country:US
Practice Address - Phone:918-967-8491
Practice Address - Fax:189-967-2552
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator