Provider Demographics
NPI:1184055816
Name:STANLEY, LETA MICHELLE (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:LETA
Middle Name:MICHELLE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:LETA
Other - Middle Name:MICHELLE
Other - Last Name:CRANDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:608 S WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-6139
Mailing Address - Country:US
Mailing Address - Phone:918-756-9411
Mailing Address - Fax:
Practice Address - Street 1:1803 S WOOD DR
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6825
Practice Address - Country:US
Practice Address - Phone:918-756-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6558101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health