MEDICARE: MARCI M. LEVERIDGE, PH.D., PC

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	103T00000X	Psychologist	851	OK

General Provider Information

NPI Number	:	1164709408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARCI M. LEVERIDGE, PH.D., PC

Provider Business Mailing Address
First Line	:	3441 W MEMORIAL RD
Second Line	:	SUITE 5
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-7000
Country	:	US
Telephone Number	:	405-749-8559
Fax Number	:	405-749-8560

Provider Business Practice Location Address
First Line	:	3441 W MEMORIAL RD
Second Line	:	SUITE 5
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-7000
Country	:	US
Telephone Number	:	405-749-8559
Fax Number	:	405-749-8560

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. MARCI LEVERIDGE
Credential	:	PH.D.
Telephone Number	:	405-749-8559

Provider Enumeration Date	:	11/15/2011
Last Update Date	:	11/15/2011

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