MEDICARE: MRS. STEPHANIE DARLEAN COLE LADC

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	101YM0800X	Mental Health Counselor	00000000000000000000
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1992036966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE DARLEAN COLE LADC

Provider Business Mailing Address
First Line	:	5509 S HUDDLESTON DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-2323
Country	:	US
Telephone Number	:	405-317-4390
Fax Number	:

Provider Business Practice Location Address
First Line	:	5509 S HUDDLESTON DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-2323
Country	:	US
Telephone Number	:	405-317-4390
Fax Number	:

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

Provider Enumeration Date	:	01/14/2010
Last Update Date	:	07/13/2020

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