Provider Demographics
NPI:1770830887
Name:NEUFELD, MARC (MS, LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:NEUFELD
Suffix:
Gender:M
Credentials:MS, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-1048
Mailing Address - Country:US
Mailing Address - Phone:580-436-7120
Mailing Address - Fax:580-436-7121
Practice Address - Street 1:501 SE 4TH ST STE C
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-6790
Practice Address - Country:US
Practice Address - Phone:580-436-7120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5310101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional