Basic Information
| Provider Information | |||||||||
| NPI: | 1730522996 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REESE | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | ANTHONY | ||||||||
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| Credential: | LPC, CBIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3105 E SKELLY DR | ||||||||
| Address2: | STE. 102 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741056358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185997404 | ||||||||
| FaxNumber: | 9185842530 | ||||||||
| Practice Location | |||||||||
| Address1: | 3105 E SKELLY DR | ||||||||
| Address2: | STE. 102 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741056358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185997404 | ||||||||
| FaxNumber: | 9185842530 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2013 | ||||||||
| LastUpdateDate: | 04/08/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 2436 | OK | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.