Provider Demographics
NPI:1447580600
Name:MESCALL, TALIESSA JEAN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:TALIESSA
Middle Name:JEAN
Last Name:MESCALL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12401 ACADIA CT
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-4801
Mailing Address - Country:US
Mailing Address - Phone:405-720-6761
Mailing Address - Fax:405-720-6761
Practice Address - Street 1:116 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-1307
Practice Address - Country:US
Practice Address - Phone:405-919-6821
Practice Address - Fax:405-701-5843
Is Sole Proprietor?:No
Enumeration Date:2010-01-10
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK506106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist