Provider Demographics
NPI:1891115093
Name:STANDARD, MARY JO (MSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:STANDARD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1729
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1729
Mailing Address - Country:US
Mailing Address - Phone:405-329-7300
Mailing Address - Fax:405-364-5379
Practice Address - Street 1:3140 W BRITTON RD
Practice Address - Street 2:STE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-2074
Practice Address - Country:US
Practice Address - Phone:405-376-4654
Practice Address - Fax:405-872-0050
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-26
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK15361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical