Healthcare Provider Details

I. General information

NPI: 1780929703
Provider Name (Legal Business Name): STEPHANIE HEFFNER MA NCC LPC-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2012
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N DALTON ST
VALLIANT OK
74764-8029
US

IV. Provider business mailing address

300 N DALTON ST
VALLIANT OK
74764-8029
US

V. Phone/Fax

Practice location:
  • Phone: 580-933-7031
  • Fax: 580-933-7034
Mailing address:
  • Phone: 580-933-7031
  • Fax: 580-933-7034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: