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General NPI Number Information
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NPI Number | 1316098734
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Entity Type | Individual
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Provider Name | MERRIE MICHAL ELISENS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/13/2007
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 222 OLIPHANT AVE SUITE 230
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City | NORMAN
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State | OK
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Zip | 73026-3701
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Country | US
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Telephone | 405-329-8454
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Fax | 405-360-8193
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Provider Business Mailing Address
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Address Line | 2420 SPRINGER DR SUITE 230
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City | NORMAN
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State | OK
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Zip | 73069-3965
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Country | US
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Telephone | 405-329-8454
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Fax | 405-360-8193
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 833
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License Number State | OK
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