Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003240110 |
---|---|
Provider Name | Mrs. Jessica Carol Stevens |
First Address | Clinton, OK 73601-9116 |
Second Address | Clinton, OK 73601-9116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2013 |
Last Update Date | 26/08/2013 |