Provider Demographics
NPI:1063643559
Name:GRIFFIN, MICHELE LENA (MED LPC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LENA
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:LENA
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED LPC
Mailing Address - Street 1:112 N. WITTE ST
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953
Mailing Address - Country:US
Mailing Address - Phone:918-839-5561
Mailing Address - Fax:918-647-2926
Practice Address - Street 1:34183 COUNTRY CLUB LN
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-9122
Practice Address - Country:US
Practice Address - Phone:918-649-7641
Practice Address - Fax:918-647-2926
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4201101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health