Healthcare Provider Details

I. General information

NPI: 1780376343
Provider Name (Legal Business Name): TERI MARIE LIEBMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 E 31ST ST
TULSA OK
74135-5012
US

IV. Provider business mailing address

1008 WASHINGTON AVE
SAND SPRINGS OK
74063-8129
US

V. Phone/Fax

Practice location:
  • Phone: 918-734-3226
  • Fax:
Mailing address:
  • Phone: 918-734-3226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: