Provider Demographics
NPI:1730598517
Name:MARY LOU TABERS, MA, LMFT, PLLC
Entity type:Organization
Organization Name:MARY LOU TABERS, MA, LMFT, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MARITAL AND FAMILY THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:TABERS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:405-436-9962
Mailing Address - Street 1:5708 NW 135TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-5942
Mailing Address - Country:US
Mailing Address - Phone:405-436-9962
Mailing Address - Fax:405-495-1655
Practice Address - Street 1:5708 NW 135TH ST STE C
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-5942
Practice Address - Country:US
Practice Address - Phone:405-436-9962
Practice Address - Fax:405-495-1655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1111106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty