Basic Information
| Provider Information | |||||||||
| NPI: | 1750772059 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARGER | ||||||||
| FirstName: | MICHAELA | ||||||||
| MiddleName: | KATHRINE | ||||||||
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| Credential: | LPC CANDIDATE | ||||||||
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| Mailing Information | |||||||||
| Address1: | RESOURCE MANAGEMENT | ||||||||
| Address2: | 1300 HOPPE BLVD., SUITE 1 | ||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804367211 | ||||||||
| FaxNumber: | 5802725757 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 ARROWHEAD DR | ||||||||
| Address2: | ADOLESCENT TRANSITIONAL LIVING CENTER | ||||||||
| City: | PAULS VALLEY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053312300 | ||||||||
| FaxNumber: | 4053312302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2015 | ||||||||
| LastUpdateDate: | 09/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.