Provider Demographics
NPI:1942286646
Name:MIHELICH, MARY L (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:L
Last Name:MIHELICH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:L
Other - Last Name:VENTONIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:8522 E 81ST PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-8001
Mailing Address - Country:US
Mailing Address - Phone:918-527-0323
Mailing Address - Fax:918-398-9475
Practice Address - Street 1:5215 E 71ST ST
Practice Address - Street 2:SUITE 1300
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6341
Practice Address - Country:US
Practice Address - Phone:918-527-0323
Practice Address - Fax:918-398-9475
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK731101YP2500X
OK554106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100715520AMedicaid