Provider Demographics
NPI:1114136314
Name:STOVALL, WILLIAM FRANK (ICADC, SAP)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:FRANK
Last Name:STOVALL
Suffix:
Gender:M
Credentials:ICADC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 74 BOX 89-5
Mailing Address - Street 2:
Mailing Address - City:HARTSHORNE
Mailing Address - State:OK
Mailing Address - Zip Code:74547-9712
Mailing Address - Country:US
Mailing Address - Phone:918-297-3047
Mailing Address - Fax:918-297-3047
Practice Address - Street 1:32 E CHEROKEE AVE STE 104
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5323
Practice Address - Country:US
Practice Address - Phone:918-423-9400
Practice Address - Fax:918-423-9400
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK280101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)