MEDICARE: DR. MARTHA BELL HALLOCK PH.D.

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	101YP2500X	Professional Counselor	1197	OK

General Provider Information

NPI Number	:	1386683332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTHA BELL HALLOCK PH.D.

Provider Business Mailing Address
First Line	:	5272 S LEWIS AVE
Second Line	:	SUITE 230
City	:	TULSA
State	:	OK
Zip	:	74105-6544
Country	:	US
Telephone Number	:	918-743-1116
Fax Number	:	918-743-1115

Provider Business Practice Location Address
First Line	:	5272 S LEWIS AVE
Second Line	:	SUITE 230
City	:	TULSA
State	:	OK
Zip	:	74105-6544
Country	:	US
Telephone Number	:	918-743-1116
Fax Number	:	918-743-1115

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	07/08/2007

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