Provider Demographics
NPI:1013253673
Name:MALTBY, PATRICIA L (LADCH/MH, LPC,)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:L
Last Name:MALTBY
Suffix:
Gender:F
Credentials:LADCH/MH, LPC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6216 S LEWIS AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1075
Mailing Address - Country:US
Mailing Address - Phone:918-960-7852
Mailing Address - Fax:539-664-5738
Practice Address - Street 1:6216 S LEWIS AVE STE 102
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136
Practice Address - Country:US
Practice Address - Phone:918-960-7852
Practice Address - Fax:539-664-5738
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-28
Last Update Date:2019-12-11
Deactivation Date:2018-10-22
Deactivation Code:
Reactivation Date:2018-10-24
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OK101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)