Provider Demographics
NPI:1528402989
Name:STEPHENS, DEDE MARANN
Entity Type:Individual
Prefix:MRS
First Name:DEDE
Middle Name:MARANN
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73432-0219
Mailing Address - Country:US
Mailing Address - Phone:580-931-7788
Mailing Address - Fax:
Practice Address - Street 1:5085 S. HWY 48
Practice Address - Street 2:
Practice Address - City:COLEMAN
Practice Address - State:OK
Practice Address - Zip Code:73432-0219
Practice Address - Country:US
Practice Address - Phone:580-931-7788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool