| Organization Name: | MICHELINE WITJENBURG PSYD PLLC |
| NPI Number: | 1013254440 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHELINE WITJENBURG (PRESIDENT) |
| Mailing Address: | 1225 W Main St Suite 102 Norman |
| State: | OK US |
| Postal Code: | 730696824 |
| Phone Number: | 4052921000 |
| Fax Number: | 4053104052 |
| NPI Enumeration Date: | 01/04/2013 |
| NPI Last Update Date: | 01/04/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 1158 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |