Provider Demographics
NPI:1972022119
Name:MORCOM, STEPHANIE LAURYN
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LAURYN
Last Name:MORCOM
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 1:4525 W BEECH AVE
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-2295
Mailing Address - Country:US
Mailing Address - Phone:940-597-0955
Mailing Address - Fax:
Practice Address - Street 1:4525 W BEECH AVE
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-2295
Practice Address - Country:US
Practice Address - Phone:940-597-0955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
OK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171W00000XOther Service ProvidersContractor