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General NPI Number Information
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NPI Number | 1154614139
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Entity Type | Individual
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Provider Name | MICQUEAL L WARE
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Gender | Female
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Dates
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Enumeration Date | 05/24/2011
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 11032 QUAIL CREEK RD STE 212
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-6220
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Country | US
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Telephone | 405-905-2074
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Fax |
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Provider Business Mailing Address
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Address Line | 4400 COLTRANE PL
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City | OKLAHOMA CITY
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State | OK
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Zip | 73121-6606
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Country | US
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Telephone | 405-609-6169
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Fax | 405-609-6169
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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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 | 5999
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License Number State | OK
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