Provider Demographics
NPI:1417234550
Name:STEPHENS, DAVID SPENCER
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:SPENCER
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:S
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16107 RIM RD.
Mailing Address - Street 2:NONE
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:504 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HENRYETTA
Practice Address - State:OK
Practice Address - Zip Code:74437-5214
Practice Address - Country:US
Practice Address - Phone:918-650-9500
Practice Address - Fax:918-650-9559
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKNO OTHER NUMBER KNOWOtherNO OTHER NUMBER KNOWN