Provider Demographics
NPI:1780952077
Name:MAATI RA COUNSELING SERVICES, PLLC
Entity type:Organization
Organization Name:MAATI RA COUNSELING SERVICES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:DIANA
Authorized Official - Last Name:MCKOY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:918-951-5727
Mailing Address - Street 1:5603 S NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-7842
Mailing Address - Country:US
Mailing Address - Phone:918-951-5727
Mailing Address - Fax:
Practice Address - Street 1:5603 S NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-7842
Practice Address - Country:US
Practice Address - Phone:918-951-5727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4675101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty