Provider Demographics
NPI:1013434117
Name:ALLISON, MARK JEFFREY I (BSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:JEFFREY
Last Name:ALLISON
Suffix:I
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 CONESTOGA DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072
Mailing Address - Country:US
Mailing Address - Phone:972-824-0727
Mailing Address - Fax:
Practice Address - Street 1:400 NORTH WALKER AVENUE
Practice Address - Street 2:SUITE 190
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102
Practice Address - Country:US
Practice Address - Phone:406-331-5945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator