Provider Demographics
NPI:1164535167
Name:SADLER, MARK S (PHD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:SADLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 S HARVARD AVE STE 200C
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2925
Mailing Address - Country:US
Mailing Address - Phone:918-743-3224
Mailing Address - Fax:918-743-9623
Practice Address - Street 1:4520 S HARVARD AVE STE 200C
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2925
Practice Address - Country:US
Practice Address - Phone:918-743-3224
Practice Address - Fax:918-743-9623
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK411103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling