Provider Demographics
NPI:1922321512
Name:SKIBA, TERRY ANN (BSW LAC)
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:ANN
Last Name:SKIBA
Suffix:
Gender:F
Credentials:BSW LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 N PORTLAND AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-6171
Mailing Address - Country:US
Mailing Address - Phone:405-605-3093
Mailing Address - Fax:405-601-5682
Practice Address - Street 1:4911 N PORTLAND AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-6171
Practice Address - Country:US
Practice Address - Phone:405-605-3093
Practice Address - Fax:405-601-5682
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1958TASMedicaid