Provider Demographics
NPI:1134356686
Name:STINSON, MARY LOUISE (LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LOUISE
Last Name:STINSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2524 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4172
Mailing Address - Country:US
Mailing Address - Phone:405-655-0100
Mailing Address - Fax:405-655-5833
Practice Address - Street 1:2524 N BROADWAY
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-4172
Practice Address - Country:US
Practice Address - Phone:405-655-0100
Practice Address - Fax:405-655-5833
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5063101Y00000X, 101YM0800X
NM0147381101YP2500X
NMT-0123201101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional