Provider Demographics
NPI:1952683039
Name:MARKS, SANDRA K (LPC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:MARKS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W MAIN ST
Mailing Address - Street 2:#103
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5136
Mailing Address - Country:US
Mailing Address - Phone:405-912-7730
Mailing Address - Fax:405-912-7726
Practice Address - Street 1:121 W MAIN ST
Practice Address - Street 2:#103
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5136
Practice Address - Country:US
Practice Address - Phone:405-912-7730
Practice Address - Fax:405-912-7726
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health