MEDICARE: MRS. MARY LOU TABERS M.A.

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	101YS0200X	School Counselor
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1841558301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY LOU TABERS M.A.

Provider Business Mailing Address
First Line	:	5708 NW 135TH ST STE C
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73142-5942
Country	:	US
Telephone Number	:	405-436-9962
Fax Number	:

Provider Business Practice Location Address
First Line	:	5708 NW 135TH ST STE C
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73142-5942
Country	:	US
Telephone Number	:	405-436-9962
Fax Number	:

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

Provider Enumeration Date	:	05/02/2012
Last Update Date	:	04/26/2026

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