Provider Demographics
NPI:1508106089
Name:STANLEY, THERESA E (BSW)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:E
Last Name:STANLEY
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:MISS
Other - First Name:THERESA
Other - Middle Name:E
Other - Last Name:NEFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3401 60TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-2106
Mailing Address - Country:US
Mailing Address - Phone:405-496-2293
Mailing Address - Fax:
Practice Address - Street 1:3401 60TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2106
Practice Address - Country:US
Practice Address - Phone:405-496-2293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK53141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical