Provider Demographics
NPI:1295156396
Name:MAXEY, AUNDRAE
Entity type:Individual
Prefix:
First Name:AUNDRAE
Middle Name:
Last Name:MAXEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9813 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74128-2603
Mailing Address - Country:US
Mailing Address - Phone:918-810-4707
Mailing Address - Fax:
Practice Address - Street 1:9813 E 7TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74128-2603
Practice Address - Country:US
Practice Address - Phone:918-810-4707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health