Provider Demographics
NPI:1811237340
Name:STEELY, ALAN DALE (MASTERS)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:DALE
Last Name:STEELY
Suffix:
Gender:M
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W 4TH ST STE D
Mailing Address - Street 2:SUITE D
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-5013
Mailing Address - Country:US
Mailing Address - Phone:918-458-0113
Mailing Address - Fax:918-458-0075
Practice Address - Street 1:1200 W 4TH ST STE D
Practice Address - Street 2:SUITE D
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-5013
Practice Address - Country:US
Practice Address - Phone:918-458-0113
Practice Address - Fax:918-458-0075
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK097178101Y00000X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool