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General NPI Number Information
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NPI Number | 1215130141
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Entity Type | Individual
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Provider Name | DEBORA RUTH MAZAHERI MS
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Gender | Female
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 06/06/2008
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Provider Practice Location Address
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Address Line | 3445 W MEMORIAL RD STE I
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City | OKLAHOMA CITY
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State | OK
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Zip | 73134-7001
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Country | US
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Telephone | 405-748-6292
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Fax | 405-748-6292
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Provider Business Mailing Address
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Address Line | PO BOX 720360
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City | OKLAHOMA CITY
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State | OK
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Zip | 73172-0360
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Country | US
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Telephone | 405-748-6292
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Fax | 405-748-6293
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 104
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 804
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 653
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License Number State | OK
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