Provider Demographics
NPI:1538498944
Name:MARTYN, MARIAL L (PHD, LCSW)
Entity Type:Individual
Prefix:
First Name:MARIAL
Middle Name:L
Last Name:MARTYN
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W GRAY ST STE 102
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-7103
Mailing Address - Country:US
Mailing Address - Phone:405-329-8821
Mailing Address - Fax:405-801-3330
Practice Address - Street 1:300 W GRAY ST STE 102
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-7103
Practice Address - Country:US
Practice Address - Phone:405-329-8821
Practice Address - Fax:405-801-3330
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical