Provider Demographics
NPI:1891240222
Name:STANFORD, DONALD
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:STANFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 COURT ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-5925
Mailing Address - Country:US
Mailing Address - Phone:918-360-7052
Mailing Address - Fax:918-683-1983
Practice Address - Street 1:1112 COURT ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5925
Practice Address - Country:US
Practice Address - Phone:918-360-7052
Practice Address - Fax:918-683-1983
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker