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General NPI Number Information
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NPI Number | 1083735625
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Entity Type | Individual
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Provider Name | STEPHANIE R NESMITH
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Gender | Female
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/09/2013
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Provider Practice Location Address
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Address Line | 27811 PORTLAND AVE
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City | BLANCHARD
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State | OK
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Zip | 73010
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Country | US
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Telephone | 580-229-6274
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Fax | 405-632-1976
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Provider Business Mailing Address
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Address Line | 27811 PORTLAND AVE
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City | BLANCHARD
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State | OK
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Zip | 73010-7150
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Country | US
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Telephone | 580-229-6247
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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