MEDICARE: MARY LOUISE WEERS

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		OK

General Provider Information

NPI Number	:	1588942742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LOUISE WEERS

Provider Business Mailing Address
First Line	:	1729 S DENVER AVE
Second Line	:	APT. 109
City	:	TULSA
State	:	OK
Zip	:	74119-4657
Country	:	US
Telephone Number	:	918-313-3094
Fax Number	:

Provider Business Practice Location Address
First Line	:	1729 S DENVER AVE
Second Line	:	APT. 109
City	:	TULSA
State	:	OK
Zip	:	74119-4657
Country	:	US
Telephone Number	:	918-313-3094
Fax Number	:

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

Provider Enumeration Date	:	07/21/2011
Last Update Date	:	07/21/2011

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Directions to “ MARY LOUISE WEERS ” Practice Location

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