MEDICARE: CYNTHIA K SPEARS

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

General Provider Information

NPI Number	:	1194973438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA K SPEARS

Provider Business Mailing Address
First Line	:	1800 JEFFERSON ROAD
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006
Country	:	US
Telephone Number	:	918-333-2775
Fax Number	:

Provider Business Practice Location Address
First Line	:	1516 S BOSTON AVE
Second Line	:	SUITE 1
City	:	TULSA
State	:	OK
Zip	:	74119-4003
Country	:	US
Telephone Number	:	918-561-6000
Fax Number	:

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

Provider Enumeration Date	:	08/28/2008
Last Update Date	:	08/25/2010

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