Basic Information
| Provider Information | |||||||||
| NPI: | 1689612863 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STANFORD | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5300 N INDEPENDENCE AVE | ||||||||
| Address2: | SUITE 280 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731125556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056043170 | ||||||||
| FaxNumber: | 4059482745 | ||||||||
| Practice Location | |||||||||
| Address1: | 5100 N BROOKLINE AVE | ||||||||
| Address2: | SUITE 950 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731123623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056043170 | ||||||||
| FaxNumber: | 4059482745 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 03/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2810 | OK | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.