Provider Demographics
NPI:1912104373
Name:HUCKEBA, WENDY MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:MARIE
Last Name:HUCKEBA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5970 E 31ST ST STE F
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-5112
Mailing Address - Country:US
Mailing Address - Phone:918-622-6599
Mailing Address - Fax:918-622-6209
Practice Address - Street 1:5970 E 31ST ST STE F
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5112
Practice Address - Country:US
Practice Address - Phone:918-622-6599
Practice Address - Fax:918-622-6209
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK889103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist