Healthcare Provider Details

I. General information

NPI: 1003197153
Provider Name (Legal Business Name): MARAH LEIGH PENSE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 E 81ST ST SUITE 5125
TULSA OK
74137-4250
US

IV. Provider business mailing address

201 MUNSEL CREEK LOOP
FLORENCE OR
97439-9235
US

V. Phone/Fax

Practice location:
  • Phone: 918-392-7875
  • Fax:
Mailing address:
  • Phone: 918-984-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC05486
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: