Healthcare Provider Details

I. General information

NPI: 1376692228
Provider Name (Legal Business Name): STEPHANIE C CRALL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8241 S WALKER AVE SUITE 200
OKLAHOMA CITY OK
73139-9401
US

IV. Provider business mailing address

8241 S WALKER AVE
OKLAHOMA CITY OK
73139-9401
US

V. Phone/Fax

Practice location:
  • Phone: 405-631-0022
  • Fax:
Mailing address:
  • Phone: 405-631-0022
  • Fax: 405-601-2951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number928
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: