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General NPI Number Information
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NPI Number | 1679872535
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Entity Type | Organization
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Legal Business Name | OKLAHOMA STATE UNIVERSITY
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Dates
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Enumeration Date | 03/17/2011
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Last Update Date | 03/17/2011
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Provider Practice Location Address
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Address Line | 101 HES-WEST OKLAHOMA STATE UNIVERSITY
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City | STILLWATER
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State | OK
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Zip | 74078-6122
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Country | US
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Telephone | 405-744-5058
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Fax | 405-744-2800
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Provider Business Mailing Address
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Address Line | 233 HES OKLAHOMA STATE UNIVERSITY
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City | STILLWATER
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State | OK
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Zip | 74078-6122
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Country | US
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Telephone | 405-744-5058
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Fax | 405-744-2800
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Authorized Official
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Title or Position | DEAN, COLLEGE OF HES
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Name | DR. STEPHAN M. WILSON
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Credential | PH.D.
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Telephone | 405-744-9805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 920
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 872
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License Number State | OK
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