Provider Demographics
NPI:1992036966
Name:COLE, STEPHANIE DARLEAN (LADC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DARLEAN
Last Name:COLE
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:DARLEAN
Other - Last Name:MBODJI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5509 S HUDDLESTON DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-2323
Mailing Address - Country:US
Mailing Address - Phone:405-317-4390
Mailing Address - Fax:
Practice Address - Street 1:5509 S HUDDLESTON DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-2323
Practice Address - Country:US
Practice Address - Phone:405-317-4390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00000000000000000000101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health