=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225386238
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIKE TEMPLETON, LPC, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2012
-----------------------------------------------------
Last Update Date | 08/22/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2300 MCKOWN DR
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73072-6678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-321-3200
-----------------------------------------------------
Fax | 405-801-2506
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1225 W MAIN ST STE 102
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73069-6824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-292-1000
-----------------------------------------------------
Fax | 405-801-2506
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, PROVIDER
-----------------------------------------------------
Name | MR. MIKE W. TEMPLETON
-----------------------------------------------------
Credential | MED
-----------------------------------------------------
Telephone | 405-292-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 3319
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------