Provider Demographics
NPI:1992004857
Name:STANLEY, TYRONE (MA)
Entity Type:Individual
Prefix:PROF
First Name:TYRONE
Middle Name:
Last Name:STANLEY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 E 2ND ST
Mailing Address - Street 2:AOT 3804
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6352
Mailing Address - Country:US
Mailing Address - Phone:917-604-1222
Mailing Address - Fax:
Practice Address - Street 1:1920 E 2ND ST
Practice Address - Street 2:AOT 3804
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6352
Practice Address - Country:US
Practice Address - Phone:917-604-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional