Provider Demographics
NPI:1457658809
Name:STOCKTON, MIKE W (BS CADC #424)
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:W
Last Name:STOCKTON
Suffix:
Gender:M
Credentials:BS CADC #424
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 SE WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-7135
Mailing Address - Country:US
Mailing Address - Phone:918-335-1111
Mailing Address - Fax:918-335-1119
Practice Address - Street 1:2200 SE WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-7135
Practice Address - Country:US
Practice Address - Phone:918-335-1111
Practice Address - Fax:918-335-1119
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK424101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100732190AMedicaid
OK100732190FMedicaid
OK100732190CMedicaid