Healthcare Provider Details

I. General information

NPI: 1073832226
Provider Name (Legal Business Name): MICHAEL MARION SYKES L.P.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 N LINCOLN BLVD
OKLAHOMA CITY OK
73105-5207
US

IV. Provider business mailing address

527 NW 23RD ST SUITE 175
OKLAHOMA CITY OK
73103-1515
US

V. Phone/Fax

Practice location:
  • Phone: 405-528-4673
  • Fax: 405-528-4674
Mailing address:
  • Phone: 405-923-0141
  • Fax: 214-540-1215

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: