Doctor Name: | MARION C STRAUB |
NPI Number: | 1265703573 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | BHRS |
License Number: | |
Business Practice Address: | 512 E 24th St Tishomingo, OK - 734603214 |
Business Phone Number: | 5803713672 |
Business Fax Number: | |
Mailing Address: | 14378 Highway 32, KINGSTON |
State: | OK |
Postal Code: | 734398133 |
Phone Number: | 5806240624 |
Fax Number: | |
NPI Enumeration Date: | 01/18/2012 |
NPI Last Update Date: | 01/18/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |