Provider Demographics
NPI:1679872535
Name:OKLAHOMA STATE UNIVERSITY
Entity Type:Organization
Organization Name:OKLAHOMA STATE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEAN, COLLEGE OF HES
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-744-9805
Mailing Address - Street 1:233 HES
Mailing Address - Street 2:OKLAHOMA STATE UNIVERSITY
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74078-6122
Mailing Address - Country:US
Mailing Address - Phone:405-744-5058
Mailing Address - Fax:405-744-2800
Practice Address - Street 1:101 HES-WEST
Practice Address - Street 2:OKLAHOMA STATE UNIVERSITY
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74078-6122
Practice Address - Country:US
Practice Address - Phone:405-744-5058
Practice Address - Fax:405-744-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK872251S00000X
OK920251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health