Healthcare Provider Details

I. General information

NPI: 1841558301
Provider Name (Legal Business Name): MARY LOU TABERS M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5708 NW 135TH ST STE C
OKLAHOMA CITY OK
73142-5942
US

IV. Provider business mailing address

5708 NW 135TH ST STE C
OKLAHOMA CITY OK
73142-5942
US

V. Phone/Fax

Practice location:
  • Phone: 405-436-9962
  • Fax:
Mailing address:
  • Phone: 405-436-9962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: