MEDICARE: MADISON LAYNE WHEAT LMSW, MSW; U/S

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
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1689388852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON LAYNE WHEAT LMSW, MSW; U/S

Provider Business Mailing Address
First Line	:	8125 S WALKER AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9417
Country	:	US
Telephone Number	:	405-634-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	8125 S WALKER AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9417
Country	:	US
Telephone Number	:	405-634-4400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2023
Last Update Date	:	10/04/2023

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