Provider Demographics
NPI:1225341803
Name:ELSEY, MICHAEL DUANE (BSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DUANE
Last Name:ELSEY
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4436 NW 50TH ST
Mailing Address - Street 2:510 5T ST. ALVA, OK 73717
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2212
Mailing Address - Country:US
Mailing Address - Phone:580-327-0565
Mailing Address - Fax:
Practice Address - Street 1:510 5TH ST.
Practice Address - Street 2:
Practice Address - City:ALVA
Practice Address - State:OK
Practice Address - Zip Code:73717
Practice Address - Country:US
Practice Address - Phone:580-327-0565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor