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NPI Code Detail

MEDICARE: MR. MICHAEL A. BLACET LCSW-P

MEDICARE: MR. MICHAEL A. BLACET LCSW-P
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
11041C0700XClinical Social Worker4693-POK

General Provider Information

NPI Number : 1831439751
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL A. BLACET LCSW-P
Provider Business Mailing Address
First Line : 2005 W TOLEDO PL
Second Line :
City : BROKEN ARROW
State : OK
Zip : 74012-5136
Country : US
Telephone Number : 918-815-5425
Fax Number :
Provider Business Practice Location Address
First Line : 4930 S SHERIDAN RD
Second Line :
City : TULSA
State : OK
Zip : 74145-5712
Country : US
Telephone Number : 918-392-4008
Fax Number : 918-392-4009
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2013
Last Update Date : 10/09/2013

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