Provider Demographics
NPI:1235469800
Name:MUKES, WILLIAM HENRY JR (LMFT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:HENRY
Last Name:MUKES
Suffix:JR
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 S. BROADWAY ST BLDG 100
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-4038
Mailing Address - Country:US
Mailing Address - Phone:316-990-1907
Mailing Address - Fax:405-241-5221
Practice Address - Street 1:2500 S BROADWAY STE 100
Practice Address - Street 2:SUITE 100
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-4039
Practice Address - Country:US
Practice Address - Phone:316-990-1907
Practice Address - Fax:405-241-5221
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1041106H00000X
KS1158106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200378070AMedicaid