Doctor Name: | STEPHANIE LYNN LAVERTY |
NPI Number: | 1104114370 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPN/LLPC |
License Number: | |
Business Practice Address: | 20740 Autumn Ct Harrah, OK - 730458143 |
Business Phone Number: | 4059740023 |
Business Fax Number: | |
Mailing Address: | 20740 Autumn Ct, HARRAH |
State: | OK |
Postal Code: | 730458143 |
Phone Number: | 4059740023 |
Fax Number: | |
NPI Enumeration Date: | 07/21/2011 |
NPI Last Update Date: | 02/04/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |