Provider Demographics
NPI:1891801130
Name:MARSH, MARY ELLYN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELLYN
Last Name:MARSH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:M.
Other - Middle Name:ELLYN
Other - Last Name:MARSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:3832 N MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2820
Mailing Address - Country:US
Mailing Address - Phone:405-949-9322
Mailing Address - Fax:405-949-9321
Practice Address - Street 1:3832 N MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2820
Practice Address - Country:US
Practice Address - Phone:405-949-9322
Practice Address - Fax:405-949-9321
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1669101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health