Provider Demographics
NPI:1386683332
Name:HALLOCK, MARTHA BELL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:BELL
Last Name:HALLOCK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5272 S LEWIS AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6544
Mailing Address - Country:US
Mailing Address - Phone:918-743-1116
Mailing Address - Fax:918-743-1115
Practice Address - Street 1:5272 S LEWIS AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6544
Practice Address - Country:US
Practice Address - Phone:918-743-1116
Practice Address - Fax:918-743-1115
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1197101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional