Provider Demographics
NPI:1174881585
Name:STEVENS, ROBERT L (LADC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:STEVENS
Suffix:
Gender:M
Credentials:LADC
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 334
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:OK
Mailing Address - Zip Code:73097-0334
Mailing Address - Country:US
Mailing Address - Phone:405-627-2356
Mailing Address - Fax:
Practice Address - Street 1:909 S MERIDIAN AVE
Practice Address - Street 2:525
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-1605
Practice Address - Country:US
Practice Address - Phone:405-627-2356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)