Provider Demographics
NPI:1245067560
Name:HAWORTH, MARTA LEE
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:LEE
Last Name:HAWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARTA
Other - Middle Name:LEE
Other - Last Name:HAWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 WOODCREEK DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OK
Mailing Address - Zip Code:73737-9706
Mailing Address - Country:US
Mailing Address - Phone:580-744-1694
Mailing Address - Fax:
Practice Address - Street 1:1625 W GARRIOTT RD STE F
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-5653
Practice Address - Country:US
Practice Address - Phone:580-242-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty