Basic Information
| Provider Information | |||||||||
| NPI: | 1013119809 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUIROZ | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | WAYNE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | BA, CM-A, BHRS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3908 E 26TH ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741144712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186366784 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7010 S YALE AVE STE 215 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741365743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184922554 | ||||||||
| FaxNumber: | 9184949870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 10030 | OK | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.