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NPI Code Detail

MEDICARE: STELLA MORA ROSS LPC

MEDICARE: STELLA MORA ROSS 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
1101YP2500XProfessional Counselor2746OK

General Provider Information

NPI Number : 1548469240
Entity Type Code : Individual
Provider Name (Legal Business Name) : STELLA MORA ROSS LPC
Provider Business Mailing Address
First Line : PO BOX 75084
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73147-0084
Country : US
Telephone Number : 415-615-7078
Fax Number :
Provider Business Practice Location Address
First Line : 420 SW 10TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73109-5610
Country : US
Telephone Number : 405-236-0701
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2007
Last Update Date : 07/12/2007

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