Provider Demographics
NPI:1225283989
Name:RAYBURN, MICHELLE JEANETTE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:JEANETTE
Last Name:RAYBURN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5022
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-5022
Mailing Address - Country:US
Mailing Address - Phone:405-202-1331
Mailing Address - Fax:
Practice Address - Street 1:5015 N PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-8891
Practice Address - Country:US
Practice Address - Phone:405-202-1331
Practice Address - Fax:405-796-7260
Is Sole Proprietor?:No
Enumeration Date:2008-11-22
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK36731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical