Provider Demographics
NPI:1508137266
Name:WARD, STEPHEN THOMAS (AA, RN, BHRS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:THOMAS
Last Name:WARD
Suffix:
Gender:M
Credentials:AA, RN, BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34183 COUNTRY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-9122
Mailing Address - Country:US
Mailing Address - Phone:918-647-6513
Mailing Address - Fax:918-647-2926
Practice Address - Street 1:34183 COUNTRY CLUB LN
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-9122
Practice Address - Country:US
Practice Address - Phone:918-647-6513
Practice Address - Fax:918-647-2926
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
OKR0104553163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No163W00000XNursing Service ProvidersRegistered Nurse