MEDICARE: MAATI RA COUNSELING SERVICES, PLLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1467790493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAATI RA COUNSELING SERVICES, PLLC

Provider Business Mailing Address
First Line	:	6539 E 31ST ST
Second Line	:	STE 4B
City	:	TULSA
State	:	OK
Zip	:	74145-1242
Country	:	US
Telephone Number	:	918-392-4965
Fax Number	:	918-392-4966

Provider Business Practice Location Address
First Line	:	6539 E 31ST ST
Second Line	:	STE 4B
City	:	TULSA
State	:	OK
Zip	:	74145-1242
Country	:	US
Telephone Number	:	918-392-4965
Fax Number	:	918-392-4966

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR/OP THERAPIST
Name	:	MAXINE D MCKOY
Credential	:	M.S., LPC, LADC
Telephone Number	:	918-951-5727

Provider Enumeration Date	:	01/25/2013
Last Update Date	:	01/25/2013

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