Provider Demographics
NPI:1114222759
Name:STEVENSON, LATESHA S (LPC)
Entity Type:Individual
Prefix:
First Name:LATESHA
Middle Name:S
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 ADAMS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-1007
Mailing Address - Country:US
Mailing Address - Phone:405-812-9905
Mailing Address - Fax:405-310-2081
Practice Address - Street 1:105 SE 45TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73129-3201
Practice Address - Country:US
Practice Address - Phone:405-632-1900
Practice Address - Fax:405-632-1976
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health