Provider Demographics
NPI:1477728566
Name:PLATA, MARIA L (MED, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:PLATA
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 PELICAN WAY
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-8992
Mailing Address - Country:US
Mailing Address - Phone:405-326-9303
Mailing Address - Fax:
Practice Address - Street 1:2701 PELICAN WAY
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-8992
Practice Address - Country:US
Practice Address - Phone:405-326-9303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2594101YP2500X
103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling