Healthcare Provider Details

I. General information

NPI: 1316821309
Provider Name (Legal Business Name): CASSIDY STEPHENS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 NW 5TH ST STE D
MOORE OK
73160-3947
US

IV. Provider business mailing address

PO BOX 400
NORMAN OK
73070-0400
US

V. Phone/Fax

Practice location:
  • Phone: 405-208-4469
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number21860
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: