Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003238999 |
---|---|
Provider Name | Miss Mariah Olden |
First Address | Oklahoma City, OK 73120 |
Second Address | Oklahoma City, OK 73120-8457 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2014 |
Last Update Date | 10/01/2014 |