Provider Demographics
NPI:1164945820
Name:ADESHINA, MARIA
Entity Type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:
Last Name:ADESHINA
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 1:11960 E 16TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74128-5816
Mailing Address - Country:US
Mailing Address - Phone:918-850-1376
Mailing Address - Fax:
Practice Address - Street 1:2027 N MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-6419
Practice Address - Country:US
Practice Address - Phone:918-592-1186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK409101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional