Provider Demographics
NPI:1801031448
Name:ROLISON, MARY ROSE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ROSE
Last Name:ROLISON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10802 QUAIL PLAZA DR
Mailing Address - Street 2:#203
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-3116
Mailing Address - Country:US
Mailing Address - Phone:405-274-7211
Mailing Address - Fax:
Practice Address - Street 1:10802 QUAIL PLAZA DR
Practice Address - Street 2:#203
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-3116
Practice Address - Country:US
Practice Address - Phone:405-274-7211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK967103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist