Healthcare Provider Details

I. General information

NPI: 1902895378
Provider Name (Legal Business Name): MARIBETH SPANIER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5512 S LEWIS AVE SUITE 8
TULSA OK
74105-7140
US

IV. Provider business mailing address

5512 S LEWIS AVE SUITE 8
TULSA OK
74105-7140
US

V. Phone/Fax

Practice location:
  • Phone: 918-743-4455
  • Fax: 918-497-1318
Mailing address:
  • Phone: 918-743-4455
  • Fax: 918-497-1318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number562
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: