Healthcare Provider Details

I. General information

NPI: 1952828295
Provider Name (Legal Business Name): STORMY C WORSTER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 08/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MCGEE DR STE 120
NORMAN OK
73072-6705
US

IV. Provider business mailing address

2801 SUMMIT TERRACE DR
NORMAN OK
73071-7195
US

V. Phone/Fax

Practice location:
  • Phone: 405-301-7610
  • Fax: 405-364-5379
Mailing address:
  • Phone: 405-301-7610
  • Fax: 405-364-5379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5149
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: