Provider Demographics
NPI:1295016376
Name:MARSHALL, VICTORIA ELLEN (BHRS)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:ELLEN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PLAZA
Mailing Address - Street 2:
Mailing Address - City:MADILL
Mailing Address - State:OK
Mailing Address - Zip Code:73446
Mailing Address - Country:US
Mailing Address - Phone:580-795-7439
Mailing Address - Fax:
Practice Address - Street 1:105 PLAZA
Practice Address - Street 2:
Practice Address - City:MADILL
Practice Address - State:OK
Practice Address - Zip Code:73446-2248
Practice Address - Country:US
Practice Address - Phone:580-795-7439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health