Provider Demographics
NPI:1124230206
Name:REDDING, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:REDDING
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 1:325 S ASH ST
Mailing Address - Street 2:
Mailing Address - City:NOWATA
Mailing Address - State:OK
Mailing Address - Zip Code:74048-4628
Mailing Address - Country:US
Mailing Address - Phone:918-273-7344
Mailing Address - Fax:918-999-0111
Practice Address - Street 1:325 S ASH ST
Practice Address - Street 2:
Practice Address - City:NOWATA
Practice Address - State:OK
Practice Address - Zip Code:74048-4628
Practice Address - Country:US
Practice Address - Phone:918-273-7344
Practice Address - Fax:918-999-0111
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLAC 1068101YA0400X
KS640106H00000X
OK1335106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200435840AMedicaid