MEDICARE: MICHELLE VERNON, PLLC

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	89	OK

General Provider Information

NPI Number	:	1972895357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHELLE VERNON, PLLC

Provider Business Mailing Address
First Line	:	13071 FAIRWAY DR
Second Line	:
City	:	CHOCTAW
State	:	OK
Zip	:	73020-8147
Country	:	US
Telephone Number	:	405-245-9233
Fax Number	:	405-632-2803

Provider Business Practice Location Address
First Line	:	6922 S WESTERN AVE
Second Line	:	SUITE 101
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-1803
Country	:	US
Telephone Number	:	405-245-9233
Fax Number	:	405-632-2803

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. MICHELLE LEE VERNON
Credential	:	M.A., LBP
Telephone Number	:	405-245-9233

Provider Enumeration Date	:	05/04/2011
Last Update Date	:	05/04/2011

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