Healthcare Provider Details

I. General information

NPI: 1487676557
Provider Name (Legal Business Name): MICHAEL LINDSEY MANES M.S., L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 S YALE AVE LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL
TULSA OK
74136-3326
US

IV. Provider business mailing address

PO BOX 21228 DEPARTMENT 31
TULSA OK
74121-1228
US

V. Phone/Fax

Practice location:
  • Phone: 918-491-3700
  • Fax:
Mailing address:
  • Phone: 918-491-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number818
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4269
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: