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General NPI Number Information
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NPI Number | 1225630494
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Entity Type | Organization
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Legal Business Name | BRIAN MICHAEL LCSW, PC
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Dates
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Enumeration Date | 11/12/2020
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Last Update Date | 12/23/2020
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Provider Practice Location Address
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Address Line | 1300 MCGEE DR STE 103
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City | NORMAN
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State | OK
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Zip | 73072-5858
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Country | US
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Telephone | 405-606-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 307 HORIZON VIEW CT
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City | NORMAN
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State | OK
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Zip | 73071-4165
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Country | US
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Telephone | 405-464-1051
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN MICHAEL
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Credential | LCSW
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Telephone | 405-464-1051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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