Healthcare Provider Details

I. General information

NPI: 1811308075
Provider Name (Legal Business Name): MACHELE ANDERSON M.S., L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 S LEWIS AVE
TULSA OK
74105-7104
US

IV. Provider business mailing address

5555 S LEWIS AVE
TULSA OK
74105-7104
US

V. Phone/Fax

Practice location:
  • Phone: 918-779-4556
  • Fax: 918-895-6917
Mailing address:
  • Phone: 918-779-4556
  • Fax: 918-895-6917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: