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General NPI Number Information
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NPI Number | 1851503486
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Entity Type | Individual
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Provider Name | TEOLA ANN MAYTUBBY MSW
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Gender | Female
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/12/2024
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Provider Practice Location Address
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Address Line | 128 N 12TH AVE
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City | DURANT
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State | OK
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Zip | 74701-4718
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Country | US
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Telephone | 580-745-9276
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Fax | 580-920-9056
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Provider Business Mailing Address
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Address Line | 107 S HIGH ST
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City | ANTLERS
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State | OK
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Zip | 74523-3818
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Country | US
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Telephone | 580-298-2830
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Fax | 580-298-6723
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9178-P
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License Number State | OK
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