Provider Demographics
NPI:1821315862
Name:DURHAM-NELSON, MARY FRANCES ELIZABETH (MED)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:FRANCES ELIZABETH
Last Name:DURHAM-NELSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16724 CREST VLY
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-6802
Mailing Address - Country:US
Mailing Address - Phone:405-370-9092
Mailing Address - Fax:
Practice Address - Street 1:16724 CREST VLY
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-6802
Practice Address - Country:US
Practice Address - Phone:405-370-9092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK300116 L101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor