Provider Demographics
NPI:1912256173
Name:OAKLEY, MARY CHRISTINE (PSYD, CC-AASP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CHRISTINE
Last Name:OAKLEY
Suffix:
Gender:F
Credentials:PSYD, CC-AASP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:ENTSMINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 N 87TH DR
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-1341
Mailing Address - Country:US
Mailing Address - Phone:602-478-2963
Mailing Address - Fax:
Practice Address - Street 1:9 N 87TH DR
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-1341
Practice Address - Country:US
Practice Address - Phone:602-478-2963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12491103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical