MEDICARE: MRS. STELLA STELIANE ANGELIDIS LPC

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	101Y00000X	Counselor	MH9745	FL
2	101Y00000X	Counselor	4804	OK
3	101Y00000X	Counselor	5339	OK

General Provider Information

NPI Number	:	1497070908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STELLA STELIANE ANGELIDIS LPC

Provider Business Mailing Address
First Line	:	6715 NORTH MAY AVENUE #102
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116
Country	:	US
Telephone Number	:	405-418-7574
Fax Number	:	405-608-4419

Provider Business Practice Location Address
First Line	:	6715 NORTH MAY AVENUE #102
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116
Country	:	US
Telephone Number	:	405-418-7574
Fax Number	:	405-608-4419

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2010
Last Update Date	:	05/30/2014

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