Healthcare Provider Details

I. General information

NPI: 1376580803
Provider Name (Legal Business Name): MR. MARVIN ROCK RICHARDSON
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: M. ROCK RICHARDSON LPC

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 WALL ST
NORMAN OK
73069-6302
US

IV. Provider business mailing address

820 WALL ST
NORMAN OK
73069-6302
US

V. Phone/Fax

Practice location:
  • Phone: 405-928-2044
  • Fax: 405-928-2049
Mailing address:
  • Phone: 405-928-2044
  • Fax: 405-928-2049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2047
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: