Provider Demographics
NPI:1841558301
Name:TABERS, MARY LOU (MA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LOU
Last Name:TABERS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5708 NW 135TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-5942
Mailing Address - Country:US
Mailing Address - Phone:405-436-9962
Mailing Address - Fax:
Practice Address - Street 1:5708 NW 135TH ST STE C
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-5942
Practice Address - Country:US
Practice Address - Phone:405-436-9962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool