MEDICARE: MS. MARILYN YEVONNE HAWKINS AS, BS, MA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor		OK

General Provider Information

NPI Number	:	1538425962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARILYN YEVONNE HAWKINS AS, BS, MA

Provider Business Mailing Address
First Line	:	2610 URBAN LEAGUE CT
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73105-3333
Country	:	US
Telephone Number	:	405-532-8581
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 NW 4TH ST STE 123
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-6540
Country	:	US
Telephone Number	:	405-601-1716
Fax Number	:

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

Provider Enumeration Date	:	04/10/2012
Last Update Date	:	04/10/2012

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