Provider Demographics
NPI:1770941205
Name:VANDERBILT-PELA, MARIE CHRISTY (MA)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:CHRISTY
Last Name:VANDERBILT-PELA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:MARIE
Other - Last Name:VANDERBILT-PELA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:1417 NW 165TH CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-7089
Mailing Address - Country:US
Mailing Address - Phone:405-266-2190
Mailing Address - Fax:
Practice Address - Street 1:2000 SONOMA PARK DR BLDG 2
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-2092
Practice Address - Country:US
Practice Address - Phone:405-659-4784
Practice Address - Fax:405-829-6385
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
OK6606101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist