Provider Demographics
NPI:1285644674
Name:SALAZAR, MICHAEL (LCSW LPC LADC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:LCSW LPC LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4535 E 38TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2544
Mailing Address - Country:US
Mailing Address - Phone:918-747-3129
Mailing Address - Fax:
Practice Address - Street 1:3105 E SKELLY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6358
Practice Address - Country:US
Practice Address - Phone:918-599-7404
Practice Address - Fax:918-584-2530
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK547101YA0400X
OK2008101YP2500X
OK21301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional