MEDICARE: ANDREW JOSEPH MARRA M.S., LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor	6448	OK

General Provider Information

NPI Number	:	1154637213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW JOSEPH MARRA M.S., LPC

Provider Business Mailing Address
First Line	:	5225 N SHARTEL AVE #201
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118
Country	:	US
Telephone Number	:	913-271-9640
Fax Number	:

Provider Business Practice Location Address
First Line	:	5225 N SHARTEL AVE STE 201
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-6035
Country	:	US
Telephone Number	:	913-271-9640
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2010
Last Update Date	:	07/21/2022

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