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General NPI Number Information
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NPI Number | 1013245364
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Entity Type | Individual
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Provider Name | MICHELLE LEE GAINES MA, LBP, CCRC
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Gender | Female
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Dates
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Enumeration Date | 11/25/2009
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Last Update Date | 12/30/2020
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Provider Practice Location Address
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Address Line | 2801 PARKLAWN DR STE 303
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City | MIDWEST CITY
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State | OK
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Zip | 73110-4230
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Country | US
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Telephone | 405-610-3644
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Fax | 405-610-3647
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Provider Business Mailing Address
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Address Line | 2801 PARKLAWN DR STE 303
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City | MIDWEST CITY
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State | OK
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Zip | 73110-4230
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Country | US
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Telephone | 405-245-9233
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Fax | 405-610-3647
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0089
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0089
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License Number State | OK
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