Provider Demographics
NPI:1376580803
Name:RICHARDSON, MARVIN ROCK
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:ROCK
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:M.
Other - Middle Name:ROCK
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:820 WALL ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6302
Mailing Address - Country:US
Mailing Address - Phone:405-928-2044
Mailing Address - Fax:405-928-2049
Practice Address - Street 1:820 WALL ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6302
Practice Address - Country:US
Practice Address - Phone:405-928-2044
Practice Address - Fax:405-928-2049
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2047101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health