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General NPI Number Information
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NPI Number | 1194170134
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Entity Type | Individual
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Provider Name | MRS. KIM STANFORD
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Gender | Female
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Dates
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Enumeration Date | 04/27/2016
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 716 S 2ND ST # 1014
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City | STILWELL
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State | OK
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Zip | 74960-4806
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Country | US
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Telephone | 919-696-6212
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Fax | 918-696-6213
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Provider Business Mailing Address
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Address Line | 162 ALYENE DR
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City | STILWELL
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State | OK
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Zip | 74960-3230
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Country | US
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Telephone | 918-575-2695
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 06968
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License Number State | OK
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