Healthcare Provider Details

I. General information

NPI: 1902350309
Provider Name (Legal Business Name): DR. JAMES BRADLEY STENNERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 ELM AVE RM 201
NORMAN OK
73019-3142
US

IV. Provider business mailing address

3200 MCKOWN DRIVE
NORMAN OK
73072
US

V. Phone/Fax

Practice location:
  • Phone: 405-325-2911
  • Fax:
Mailing address:
  • Phone: 405-310-9772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1265
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: