MEDICARE: MARY LOU TABERS, MA, LMFT, 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	106H00000X	Marriage & Family Therapist	1111	OK

General Provider Information

NPI Number	:	1730598517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY LOU TABERS, MA, LMFT, PLLC

Provider Business Mailing Address
First Line	:	5708 NW 135TH ST STE C
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73142-5942
Country	:	US
Telephone Number	:	405-436-9962
Fax Number	:	405-495-1655

Provider Business Practice Location Address
First Line	:	5708 NW 135TH ST STE C
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73142-5942
Country	:	US
Telephone Number	:	405-436-9962
Fax Number	:	405-495-1655

Authorized Official
Title or Position	:	MARITAL AND FAMILY THERAPIST
Name	:	MRS. MARY LOU TABERS
Credential	:	MA, LMFT
Telephone Number	:	405-436-9962

Provider Enumeration Date	:	08/06/2014
Last Update Date	:	08/06/2014

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