Individual
MARION C STRAUB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BHRS
Contact information
Practice address
512 E 24TH ST, TISHOMINGO, OK 73460-3214
(580) 371-3672
Mailing address
14378 HIGHWAY 32, KINGSTON, OK 73439-8133
(580) 624-0624
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200049040
—
OK
Enumeration date
01/18/2012
Last updated
01/18/2012
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