Provider Demographics
NPI:1770022956
Name:DAVIS, STEPHANIE LEE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEE
Last Name:DAVIS
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 1:229 W GENTRY AVE
Mailing Address - Street 2:
Mailing Address - City:CHECOTAH
Mailing Address - State:OK
Mailing Address - Zip Code:74426-2439
Mailing Address - Country:US
Mailing Address - Phone:918-473-1575
Mailing Address - Fax:918-473-3185
Practice Address - Street 1:229 W GENTRY AVE
Practice Address - Street 2:
Practice Address - City:CHECOTAH
Practice Address - State:OK
Practice Address - Zip Code:74426-2439
Practice Address - Country:US
Practice Address - Phone:918-473-1575
Practice Address - Fax:918-473-3185
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker