MEDICARE: FILIZ SPROUSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	11049	OK

General Provider Information

NPI Number	:	1578288791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FILIZ SPROUSE

Provider Business Mailing Address
First Line	:	4000 SE 111TH CT
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73160-9303
Country	:	US
Telephone Number	:	405-519-2798
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 SE 111TH CT
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73160-9303
Country	:	US
Telephone Number	:	405-519-2798
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2022
Last Update Date	:	10/10/2022

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Directions to “ FILIZ SPROUSE ” Practice Location

Language	Start Address	Practice Location

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