Provider Demographics
NPI:1780929703
Name:HEFFNER, STEPHANIE (MA NCC LPC-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HEFFNER
Suffix:
Gender:F
Credentials:MA NCC LPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N DALTON ST
Mailing Address - Street 2:
Mailing Address - City:VALLIANT
Mailing Address - State:OK
Mailing Address - Zip Code:74764-8029
Mailing Address - Country:US
Mailing Address - Phone:580-933-7031
Mailing Address - Fax:580-933-7034
Practice Address - Street 1:300 N DALTON ST
Practice Address - Street 2:
Practice Address - City:VALLIANT
Practice Address - State:OK
Practice Address - Zip Code:74764-8029
Practice Address - Country:US
Practice Address - Phone:580-933-7031
Practice Address - Fax:580-933-7034
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1780929703Medicaid