Provider Demographics
NPI:1851503486
Name:MAYTUBBY, TEOLA ANN (MSW)
Entity type:Individual
Prefix:MISS
First Name:TEOLA
Middle Name:ANN
Last Name:MAYTUBBY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:TEOLA
Other - Middle Name:ANN
Other - Last Name:DURANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-3818
Mailing Address - Country:US
Mailing Address - Phone:580-298-2830
Mailing Address - Fax:580-298-6723
Practice Address - Street 1:128 N 12TH AVE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-4718
Practice Address - Country:US
Practice Address - Phone:580-745-9276
Practice Address - Fax:580-920-9056
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OK9178-P1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor