Provider Demographics
NPI:1003035817
Name:MAYBERRY, PAUL A
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:A
Last Name:MAYBERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2131
Mailing Address - Country:US
Mailing Address - Phone:918-747-7373
Mailing Address - Fax:918-747-0197
Practice Address - Street 1:4444 E 31ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2131
Practice Address - Country:US
Practice Address - Phone:918-747-7373
Practice Address - Fax:918-747-0197
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist