Provider Demographics
NPI:1396077459
Name:LAND-MORREL, MARY CATHRINE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CATHRINE
Last Name:LAND-MORREL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3631 S ELM PL STE 804
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-1859
Mailing Address - Country:US
Mailing Address - Phone:918-486-9255
Mailing Address - Fax:
Practice Address - Street 1:3631 S ELM PL STE 804
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74011-1859
Practice Address - Country:US
Practice Address - Phone:918-486-9255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-31
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1072106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist