Healthcare Provider Details

I. General information

NPI: 1285644674
Provider Name (Legal Business Name): MICHAEL SALAZAR LCSW LPC LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 E SKELLY DR SUITE 102
TULSA OK
74105-6358
US

IV. Provider business mailing address

4535 E 38TH PL
TULSA OK
74135-2544
US

V. Phone/Fax

Practice location:
  • Phone: 918-599-7404
  • Fax: 918-584-2530
Mailing address:
  • Phone: 918-747-3129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number547
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2008
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2130
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: