Healthcare Provider Details

I. General information

NPI: 1942286646
Provider Name (Legal Business Name): MARY L. MIHELICH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY L VENTONIS PHD

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 E 71ST ST SUITE 1300
TULSA OK
74136-6341
US

IV. Provider business mailing address

8522 E 81ST PL
TULSA OK
74133-8001
US

V. Phone/Fax

Practice location:
  • Phone: 918-527-0323
  • Fax: 918-398-9475
Mailing address:
  • Phone: 918-527-0323
  • Fax: 918-398-9475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number731
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number554
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: