Provider Demographics
NPI:1376831917
Name:HARRIS, STELLA (MBAHM)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MBAHM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-7602
Mailing Address - Country:US
Mailing Address - Phone:918-245-5565
Mailing Address - Fax:
Practice Address - Street 1:117 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-7602
Practice Address - Country:US
Practice Address - Phone:918-245-5565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker