Provider Demographics
NPI:1134440662
Name:MCKOY, MAXINE DIANA (THERAPIST/COUNSELOR)
Entity type:Individual
Prefix:MS
First Name:MAXINE
Middle Name:DIANA
Last Name:MCKOY
Suffix:
Gender:F
Credentials:THERAPIST/COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2231
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74067-2231
Mailing Address - Country:US
Mailing Address - Phone:918-951-5727
Mailing Address - Fax:
Practice Address - Street 1:1843 E 15TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4610
Practice Address - Country:US
Practice Address - Phone:918-951-5727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)