Healthcare Provider Details

I. General information

NPI: 1457572257
Provider Name (Legal Business Name): MIKE COVINGTON LPC, LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S FRETZ AVE
EDMOND OK
73003-5532
US

IV. Provider business mailing address

1512 GEORGE ST
EDMOND OK
73003-3800
US

V. Phone/Fax

Practice location:
  • Phone: 405-726-9808
  • Fax: 405-726-9809
Mailing address:
  • Phone: 405-826-4867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number536
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3610
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: