Provider Demographics
NPI:1790060861
Name:STEVENS, ALLISON M (MAT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:M
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MAT
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 295
Mailing Address - Street 2:
Mailing Address - City:BOLEY
Mailing Address - State:OK
Mailing Address - Zip Code:74829-0295
Mailing Address - Country:US
Mailing Address - Phone:918-667-3778
Mailing Address - Fax:918-667-3443
Practice Address - Street 1:222 N MAPLE
Practice Address - Street 2:
Practice Address - City:BOLEY
Practice Address - State:OK
Practice Address - Zip Code:74829
Practice Address - Country:US
Practice Address - Phone:918-667-3778
Practice Address - Fax:918-667-3443
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200271430AOtherDMH CONTRACTED
OK200277590AOtherDMH CONTRACTED
OK200277580AOtherDMH CONTRACTED