Basic Information
| Provider Information | |||||||||
| NPI: | 1285644674 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALAZAR | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW LPC LADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4535 E 38TH PL | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741352544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187473129 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3105 E SKELLY DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741056358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185997404 | ||||||||
| FaxNumber: | 9185842530 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 11/14/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 547 | OK | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | 2008 | OK | N | Behavioral Health & Social Service Providers | Counselor | Professional | 1041C0700X | 2130 | OK | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.