Provider Demographics
NPI:1770223521
Name:THURMAN, MARCELLUS TYRONE
Entity Type:Individual
Prefix:MR
First Name:MARCELLUS
Middle Name:TYRONE
Last Name:THURMAN
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 1:121 W HUGHBERT ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-7705
Mailing Address - Country:US
Mailing Address - Phone:405-436-4206
Mailing Address - Fax:
Practice Address - Street 1:121 W HUGHBERT ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-7705
Practice Address - Country:US
Practice Address - Phone:405-436-4206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator