Healthcare Provider Details

I. General information

NPI: 1255789178
Provider Name (Legal Business Name): ADDISON BAILIE MCCONNELL BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ADDISON BALIE GUTHRIE BA

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 E MAIN ST
STIGLER OK
74462-2804
US

IV. Provider business mailing address

PO BOX 179
STIGLER OK
74462-0179
US

V. Phone/Fax

Practice location:
  • Phone: 800-640-9741
  • Fax: 918-967-3351
Mailing address:
  • Phone: 800-640-9741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10532
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: