Basic Information
| Provider Information | |||||||||
| NPI: | 1457602864 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCALISTER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | LEON | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | MS, LPC-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2508 E 71ST ST STE C | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741365572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187946570 | ||||||||
| FaxNumber: | 9183405189 | ||||||||
| Practice Location | |||||||||
| Address1: | 2508 E 71ST ST STE C | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741365572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187946570 | ||||||||
| FaxNumber: | 9183405189 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2012 | ||||||||
| LastUpdateDate: | 03/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor |
No ID Information.