Provider Demographics
NPI:1083772024
Name:LEVERIDGE, MARCI M (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARCI
Middle Name:M
Last Name:LEVERIDGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3441 W MEMORIAL RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-7000
Mailing Address - Country:US
Mailing Address - Phone:405-749-8559
Mailing Address - Fax:405-749-8560
Practice Address - Street 1:3441 W MEMORIAL RD
Practice Address - Street 2:SUITE 5
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-7000
Practice Address - Country:US
Practice Address - Phone:405-749-8559
Practice Address - Fax:405-749-8560
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK851103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist