Provider Demographics
NPI:1023369840
Name:MANTLE, MARY F
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:F
Last Name:MANTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 GLEN EAGLES CT
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-8501
Mailing Address - Country:US
Mailing Address - Phone:970-420-1374
Mailing Address - Fax:
Practice Address - Street 1:330 W GRAY ST
Practice Address - Street 2:SUITE 140
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-7129
Practice Address - Country:US
Practice Address - Phone:405-919-6821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst