Provider Demographics
NPI:1346621281
Name:DEGAN, MICHAEL GARRETT (MCP, LADC, LPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GARRETT
Last Name:DEGAN
Suffix:
Gender:M
Credentials:MCP, LADC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 WHITE EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-8307
Mailing Address - Country:US
Mailing Address - Phone:580-762-3421
Mailing Address - Fax:580-762-3413
Practice Address - Street 1:200 WHITE EAGLE DR
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-8315
Practice Address - Country:US
Practice Address - Phone:580-762-3421
Practice Address - Fax:580-762-3413
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7221101YM0800X
OK1354101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health