Healthcare Provider Details

I. General information

NPI: 1154812774
Provider Name (Legal Business Name): MICHAEL BLAINE HOUGH LCSW, MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 S VIRGINIA AVE
BARTLESVILLE OK
74003-4439
US

IV. Provider business mailing address

1604 S JOHNSTONE AVE
BARTLESVILLE OK
74003-5718
US

V. Phone/Fax

Practice location:
  • Phone: 918-337-8080
  • Fax: 918-337-8099
Mailing address:
  • Phone: 918-330-9493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21218
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: