Provider Demographics
NPI:1598001471
Name:ROY, MARIBEL (LPC CANDIDATE, BA)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:ROY
Suffix:
Gender:F
Credentials:LPC CANDIDATE, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 285
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-0285
Mailing Address - Country:US
Mailing Address - Phone:918-413-3225
Mailing Address - Fax:918-649-0404
Practice Address - Street 1:205 DEWEY AVE STE 2
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4224
Practice Address - Country:US
Practice Address - Phone:918-649-0909
Practice Address - Fax:918-649-0404
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103TR0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation