Provider Demographics
NPI:1285847624
Name:FORIS, ANGIE MYREE (BSW)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:MYREE
Last Name:FORIS
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:MYREE
Other - Last Name:HEAROD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-0179
Mailing Address - Country:US
Mailing Address - Phone:918-967-3368
Mailing Address - Fax:918-967-4582
Practice Address - Street 1:628 E CREEK AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-6930
Practice Address - Country:US
Practice Address - Phone:918-423-6030
Practice Address - Fax:918-423-2370
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK958101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)