Provider Demographics
NPI:1073044160
Name:MASTALIR, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MASTALIR
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 1:10317 GREENBRIAR PL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7651
Mailing Address - Country:US
Mailing Address - Phone:405-703-0061
Mailing Address - Fax:
Practice Address - Street 1:10317 GREENBRIAR PL
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7651
Practice Address - Country:US
Practice Address - Phone:405-703-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional