Provider Demographics
NPI:1831565076
Name:MAHURIN, MARCIA
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:MAHURIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11748 N 2420 RD
Mailing Address - Street 2:
Mailing Address - City:COLONY
Mailing Address - State:OK
Mailing Address - Zip Code:73021-2007
Mailing Address - Country:US
Mailing Address - Phone:580-302-2425
Mailing Address - Fax:405-285-1652
Practice Address - Street 1:11748 N 2420 RD
Practice Address - Street 2:
Practice Address - City:COLONY
Practice Address - State:OK
Practice Address - Zip Code:73021-2007
Practice Address - Country:US
Practice Address - Phone:580-302-2425
Practice Address - Fax:405-285-1652
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3603101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health