MEDICARE: MRS. MICHELLE LYNN STINNETT

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1508200494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE LYNN STINNETT

Provider Business Mailing Address
First Line	:	2520 ARLINGTON BLVD
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-4622
Country	:	US
Telephone Number	:	580-235-7508
Fax Number	:

Provider Business Practice Location Address
First Line	:	2520 ARLINGTON BLVD
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-4622
Country	:	US
Telephone Number	:	580-235-7508
Fax Number	:

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

Provider Enumeration Date	:	04/22/2013
Last Update Date	:	04/22/2013

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