MEDICARE: MARY LOU NURRIESTEARNS LCSW

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	1041C0700X	Clinical Social Worker	1077	OK

General Provider Information

NPI Number	:	1861422149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LOU NURRIESTEARNS LCSW

Provider Business Mailing Address
First Line	:	4870 S LEWIS AVE
Second Line	:	SUITE 205
City	:	TULSA
State	:	OK
Zip	:	74105-5151
Country	:	US
Telephone Number	:	918-745-9233
Fax Number	:	918-683-1445

Provider Business Practice Location Address
First Line	:	4870 S LEWIS AVE
Second Line	:	SUITE 205
City	:	TULSA
State	:	OK
Zip	:	74105-5151
Country	:	US
Telephone Number	:	918-745-9233
Fax Number	:	918-683-1445

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	12/08/2015

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1023103371 — JOHN DUNCAN CUTRIGHT M.S.W., L.C.S.W.
Practice Location Address:

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