Provider Demographics
NPI:1063743094
Name:ESTEP, STEPHEN JERRY
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JERRY
Last Name:ESTEP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1342
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-6342
Mailing Address - Country:US
Mailing Address - Phone:580-364-2077
Mailing Address - Fax:
Practice Address - Street 1:1501 S VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-3233
Practice Address - Country:US
Practice Address - Phone:580-889-3799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker