Provider Demographics
NPI:1578879706
Name:STEPHENS, CONNIE M (MHR, LPC - C)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:M
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MHR, LPC - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 S GARY PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5219
Mailing Address - Country:US
Mailing Address - Phone:918-748-8488
Mailing Address - Fax:
Practice Address - Street 1:1616 S GARY PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5219
Practice Address - Country:US
Practice Address - Phone:918-748-8488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200081620BMedicaid
OK200081620AMedicaid