Healthcare Provider Details

I. General information

NPI: 1841593936
Provider Name (Legal Business Name): MIKE NORTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2010
Last Update Date: 12/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E MARSHALL DR
MIDWEST CITY OK
73110-5332
US

IV. Provider business mailing address

301 E MARSHALL DR
MIDWEST CITY OK
73110-5332
US

V. Phone/Fax

Practice location:
  • Phone: 405-824-9284
  • Fax:
Mailing address:
  • Phone: 405-824-9284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: