Provider Demographics
NPI:1720840994
Name:LOUCKS, MARIE IRENE (MA)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:IRENE
Last Name:LOUCKS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 QUARTZ RD
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:OK
Mailing Address - Zip Code:74740-5388
Mailing Address - Country:US
Mailing Address - Phone:580-916-2357
Mailing Address - Fax:
Practice Address - Street 1:204 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:OK
Practice Address - Zip Code:74728-3976
Practice Address - Country:US
Practice Address - Phone:580-584-2478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health