Provider Demographics
NPI:1366817108
Name:STONE, CANDACE (ASSOCIATES)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:ASSOCIATES
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:
Other - Last Name:BLASSENGILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASSOCIATES
Mailing Address - Street 1:2912 PAXTON PL
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:OK
Mailing Address - Zip Code:73084-3506
Mailing Address - Country:US
Mailing Address - Phone:405-906-1580
Mailing Address - Fax:
Practice Address - Street 1:909 ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-5229
Practice Address - Country:US
Practice Address - Phone:405-360-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-04
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKJ082805008101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health