Provider Demographics
NPI:1902895378
Name:SPANIER, MARIBETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIBETH
Middle Name:
Last Name:SPANIER
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 1:5512 S LEWIS AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-7140
Mailing Address - Country:US
Mailing Address - Phone:918-743-4455
Mailing Address - Fax:918-497-1318
Practice Address - Street 1:5512 S LEWIS AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-7140
Practice Address - Country:US
Practice Address - Phone:918-743-4455
Practice Address - Fax:918-497-1318
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK562103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100839030AMedicaid