Provider Demographics
NPI:1467128371
Name:MAGAR, BOB J
Entity Type:Individual
Prefix:MR
First Name:BOB
Middle Name:J
Last Name:MAGAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 OAK DR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73170-7904
Mailing Address - Country:US
Mailing Address - Phone:405-921-0560
Mailing Address - Fax:405-228-2525
Practice Address - Street 1:228 ROBERT S KERR AVE STE 715
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-5206
Practice Address - Country:US
Practice Address - Phone:405-921-0560
Practice Address - Fax:405-228-2525
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK352101YA0400X
OK1420101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health