Provider Demographics
NPI:1215130141
Name:MAZAHERI, DEBORA RUTH (MS)
Entity type:Individual
Prefix:
First Name:DEBORA
Middle Name:RUTH
Last Name:MAZAHERI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:
Other - Last Name:BARAJAS-MAZAHERI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS LPC LMFT LADC
Mailing Address - Street 1:PO BOX 720360
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73172-0360
Mailing Address - Country:US
Mailing Address - Phone:405-748-6292
Mailing Address - Fax:405-748-6293
Practice Address - Street 1:3445 W MEMORIAL RD STE I
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-7001
Practice Address - Country:US
Practice Address - Phone:405-748-6292
Practice Address - Fax:405-748-6292
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK104101YA0400X
OK804101YP2500X
OK653106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist