MEDICARE: STONEBRIDGE FAMILY SERVICES, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor
2	106H00000X	Marriage & Family Therapist	896	OK

General Provider Information

NPI Number	:	1306010640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STONEBRIDGE FAMILY SERVICES, PC

Provider Business Mailing Address
First Line	:	530 POINTE PARKWAY BLVD
Second Line	:	SUITE B
City	:	YUKON
State	:	OK
Zip	:	73099-0600
Country	:	US
Telephone Number	:	405-708-3640
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 POINTE PARKWAY BLVD
Second Line	:	SUITE B
City	:	YUKON
State	:	OK
Zip	:	73099-0600
Country	:	US
Telephone Number	:	405-708-3640
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BRANDI MORGAN
Credential	:	LMFT
Telephone Number	:	405-708-3640

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	04/07/2015

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