Healthcare Provider Details

I. General information

NPI: 1437020344
Provider Name (Legal Business Name): MARY SALINA WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 10/24/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 CHICKASAW BLVD
ARDMORE OK
73401-1341
US

IV. Provider business mailing address

124 E MAIN ST STE B4
ADA OK
74820-5623
US

V. Phone/Fax

Practice location:
  • Phone: 580-222-2884
  • Fax: 580-272-5757
Mailing address:
  • Phone: 580-436-7206
  • Fax: 580-272-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12923
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: