Provider Demographics
NPI:1043537434
Name:KING, MARIAN J
Entity Type:Individual
Prefix:MRS
First Name:MARIAN
Middle Name:J
Last Name:KING
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 1:7955 S YALE AVE APT A
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-9010
Mailing Address - Country:US
Mailing Address - Phone:616-834-8111
Mailing Address - Fax:
Practice Address - Street 1:24797 S HWY 66 UNIT 5
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74019-2402
Practice Address - Country:US
Practice Address - Phone:918-342-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral