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General NPI Number Information
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NPI Number | 1386896165
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Entity Type | Organization
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Legal Business Name | MARTHA B. HALLOCK PH.D., P.C.
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Dates
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Enumeration Date | 10/13/2008
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Last Update Date | 10/13/2008
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Provider Practice Location Address
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Address Line | 5272 S LEWIS AVE SUITE 230
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City | TULSA
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State | OK
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Zip | 74105-6544
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Country | US
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Telephone | 918-743-1116
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Fax | 918-743-1115
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Provider Business Mailing Address
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Address Line | 5272 S LEWIS AVE SUITE 230
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City | TULSA
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State | OK
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Zip | 74105-6544
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Country | US
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Telephone | 918-743-1116
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Fax | 918-743-1115
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARTHA BELL HALLOCK
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Credential | PH.D.
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Telephone | 918-743-1116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1197
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License Number State | OK
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