Provider Demographics
NPI:1275859142
Name:MARGERUM, DEBORAH LOUELLA (MCP,LPC CANDIDATE)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LOUELLA
Last Name:MARGERUM
Suffix:
Gender:F
Credentials:MCP,LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BRIDGEWAY, INC
Mailing Address - Street 2:620 W GRAND
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601
Mailing Address - Country:US
Mailing Address - Phone:580-762-1462
Mailing Address - Fax:580-765-7299
Practice Address - Street 1:BRIDGEWAY, INC.
Practice Address - Street 2:620 W GRAND
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-5123
Practice Address - Country:US
Practice Address - Phone:580-762-1462
Practice Address - Fax:580-765-7299
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6332101YM0800X
OK1222101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health