Provider Demographics
NPI:1942555271
Name:MARZETT-HOWELL, STARDAVANA
Entity Type:Individual
Prefix:
First Name:STARDAVANA
Middle Name:
Last Name:MARZETT-HOWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 NW 102ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-5314
Mailing Address - Country:US
Mailing Address - Phone:405-923-4387
Mailing Address - Fax:
Practice Address - Street 1:7250 NW EXPRESSWAY STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-1522
Practice Address - Country:US
Practice Address - Phone:405-525-0452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100719930AMedicaid