Doctor Name: | MICHAEL RAY LAVINE |
NPI Number: | 1285991752 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | BHRS |
License Number: | |
Business Practice Address: | 2513 Nw 115th Okc, OK - 73120 |
Business Phone Number: | 4052060719 |
Business Fax Number: | |
Mailing Address: | 2513 Nw 115th, OKLAHOMA |
State: | OK |
Postal Code: | 73120 |
Phone Number: | 4052060719 |
Fax Number: | |
NPI Enumeration Date: | 04/20/2012 |
NPI Last Update Date: | 05/24/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |