Provider Demographics
NPI:1386896165
Name:MARTHA B. HALLOCK PH.D., P.C.
Entity type:Organization
Organization Name:MARTHA B. HALLOCK PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:BELL
Authorized Official - Last Name:HALLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:918-743-1116
Mailing Address - Street 1:5272 S LEWIS AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6544
Mailing Address - Country:US
Mailing Address - Phone:918-743-1116
Mailing Address - Fax:918-743-1115
Practice Address - Street 1:5272 S LEWIS AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6544
Practice Address - Country:US
Practice Address - Phone:918-743-1116
Practice Address - Fax:918-743-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1197101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty