Basic Information
| Provider Information | |||||||||
| NPI: | 1447580600 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MESCALL | ||||||||
| FirstName: | TALIESSA | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12401 ACADIA CT | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731424801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057206761 | ||||||||
| FaxNumber: | 4057206761 | ||||||||
| Practice Location | |||||||||
| Address1: | 116 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730691307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059196821 | ||||||||
| FaxNumber: | 4057015843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2010 | ||||||||
| LastUpdateDate: | 01/27/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 506 | OK | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.