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NPI Code Detail

MEDICARE: MR. MICHAEL LEON MCCALISTER II MS, LPC-C

MEDICARE: MR. MICHAEL LEON MCCALISTER II MS, LPC-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2101Y00000XCounselor

General Provider Information

NPI Number : 1457602864
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL LEON MCCALISTER II MS, LPC-C
Provider Business Mailing Address
First Line : 2508 E 71ST ST STE C
Second Line :
City : TULSA
State : OK
Zip : 74136-5572
Country : US
Telephone Number : 918-794-6570
Fax Number : 918-340-5189
Provider Business Practice Location Address
First Line : 2508 E 71ST ST STE C
Second Line :
City : TULSA
State : OK
Zip : 74136-5572
Country : US
Telephone Number : 918-794-6570
Fax Number : 918-340-5189
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2012
Last Update Date : 03/23/2020

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