Healthcare Provider Details

I. General information

NPI: 1891212551
Provider Name (Legal Business Name): MARY ELIZABETH MOHON PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 08/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OKLAHOMA VAMC 921 NE 13TH STREET 11G
OKLAHOMA CITY OK
73104
US

IV. Provider business mailing address

10704 S WINSTON WAY
OKLAHOMA CITY OK
73170-5214
US

V. Phone/Fax

Practice location:
  • Phone: 405-456-1334
  • Fax:
Mailing address:
  • Phone: 405-323-7791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number1285
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: