Provider Demographics
NPI:1922347517
Name:STANLEY, KATINA DANELLE
Entity Type:Individual
Prefix:MISS
First Name:KATINA
Middle Name:DANELLE
Last Name:STANLEY
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:PO BOX 48580
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74148-0580
Mailing Address - Country:US
Mailing Address - Phone:918-955-7207
Mailing Address - Fax:
Practice Address - Street 1:4036 N ELGIN AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-1517
Practice Address - Country:US
Practice Address - Phone:918-955-7207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-03
Last Update Date:2013-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor