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NPI Code Detail

MEDICARE: MS. MARY WATERS-BILBO LPC

MEDICARE: MS. MARY WATERS-BILBO 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
1101YM0800XMental Health Counselor3788OK

General Provider Information

NPI Number : 1457816704
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY WATERS-BILBO LPC
Provider Business Mailing Address
First Line : 5 PARK PL
Second Line :
City : ANNAPOLIS
State : MD
Zip : 21401-3298
Country : US
Telephone Number : 918-640-9453
Fax Number :
Provider Business Practice Location Address
First Line : 6216 S LEWIS AVE STE 102
Second Line :
City : TULSA
State : OK
Zip : 74136-1075
Country : US
Telephone Number : 918-268-7263
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2019
Last Update Date : 01/12/2024

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