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General NPI Number Information
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NPI Number | 1487169629
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Entity Type | Organization
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Legal Business Name | JERRY STANKEWITZ M.ED., LPC PLLC
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Dates
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Enumeration Date | 12/11/2017
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Last Update Date | 12/11/2017
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Provider Practice Location Address
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Address Line | 1301 S BROADWAY AVE STE 2
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City | POTEAU
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State | OK
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Zip | 74953-5268
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Country | US
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Telephone | 918-839-5105
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Fax |
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Provider Business Mailing Address
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Address Line | 28894 HUCKLEBERRY LN
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City | POTEAU
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State | OK
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Zip | 74953-8724
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | JERRY STANKEWITZ
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Credential | M.ED., LPC
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Telephone | 918-647-1642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6081
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License Number State | OK
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