Provider Demographics
NPI:1114947082
Name:TEARL, DALEY (LMFT, LADC)
Entity Type:Individual
Prefix:
First Name:DALEY
Middle Name:
Last Name:TEARL
Suffix:
Gender:M
Credentials:LMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 S. 359TH W PL
Mailing Address - Street 2:P.O. BOX 1723
Mailing Address - City:MANNFORD
Mailing Address - State:OK
Mailing Address - Zip Code:74044
Mailing Address - Country:US
Mailing Address - Phone:918-865-8212
Mailing Address - Fax:
Practice Address - Street 1:100 W 7TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-5007
Practice Address - Country:US
Practice Address - Phone:918-758-1910
Practice Address - Fax:918-756-1270
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK265101YA0400X
OK821106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK300522336OtherMEDICARE