Provider Demographics
NPI:1588942742
Name:WEERS, MARY LOUISE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LOUISE
Last Name:WEERS
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 1:1729 S DENVER AVE
Mailing Address - Street 2:APT. 109
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119-4657
Mailing Address - Country:US
Mailing Address - Phone:918-313-3094
Mailing Address - Fax:
Practice Address - Street 1:1729 S DENVER AVE
Practice Address - Street 2:APT. 109
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-4657
Practice Address - Country:US
Practice Address - Phone:918-313-3094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health