Provider Demographics
NPI:1396187878
Name:MATHENIA, LIKKIA
Entity Type:Individual
Prefix:
First Name:LIKKIA
Middle Name:
Last Name:MATHENIA
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 1:609 REV J A REED JR AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-3812
Mailing Address - Country:US
Mailing Address - Phone:405-201-3919
Mailing Address - Fax:
Practice Address - Street 1:817 NE 63RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-6411
Practice Address - Country:US
Practice Address - Phone:405-753-7159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health