Provider Demographics
NPI:1992043830
Name:AERY, STEPHEN RAY
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:RAY
Last Name:AERY
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 1:8824 TIMBERLAKE DR
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-8452
Mailing Address - Country:US
Mailing Address - Phone:918-361-2505
Mailing Address - Fax:
Practice Address - Street 1:8824 TIMBERLAKE DR
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-8452
Practice Address - Country:US
Practice Address - Phone:918-361-2505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional