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General NPI Number Information
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NPI Number | 1114136314
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Entity Type | Individual
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Provider Name | WILLIAM FRANK STOVALL ICADC, SAP
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Gender | Male
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 32 E CHEROKEE AVE STE 104
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City | MCALESTER
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State | OK
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Zip | 74501-5323
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Country | US
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Telephone | 918-423-9400
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Fax | 918-423-9400
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Provider Business Mailing Address
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Address Line | HC 74 BOX 89-5
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City | HARTSHORNE
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State | OK
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Zip | 74547-9712
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Country | US
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Telephone | 918-297-3047
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Fax | 918-297-3047
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 280
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License Number State | OK
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