Provider Demographics
NPI:1285925610
Name:ROEBUCK, STEPHANIE (LMFT CANDIDATE, CMII)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:ROEBUCK
Suffix:
Gender:F
Credentials:LMFT CANDIDATE, CMII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 NW CACHE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5258
Mailing Address - Country:US
Mailing Address - Phone:580-351-9998
Mailing Address - Fax:580-351-9898
Practice Address - Street 1:2215 NW CACHE RD STE 107
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5258
Practice Address - Country:US
Practice Address - Phone:580-351-9998
Practice Address - Fax:580-351-9898
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist