Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | ||
N | 225400000X | Rehabilitation Practitioner |
NPI | 1003197153 |
---|---|
Provider Name | Marah Leigh Pense |
First Address | Tulsa, OK 74136-1363 |
Second Address | Tulsa, OK 74137-4250 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2011 |
Last Update Date | 08/10/2012 |