Provider Demographics
NPI:1154648244
Name:WILLEFORD, MICAH E (MS)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:E
Last Name:WILLEFORD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MICAH
Other - Middle Name:E
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:3838 NW 36TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2916
Mailing Address - Country:US
Mailing Address - Phone:405-408-8202
Mailing Address - Fax:405-702-9031
Practice Address - Street 1:3838 NW 36TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2916
Practice Address - Country:US
Practice Address - Phone:405-408-8202
Practice Address - Fax:405-702-9031
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor