Provider Demographics
NPI:1396025243
Name:MCDOLE, MSICHANA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MSICHANA
Middle Name:
Last Name:MCDOLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 SE 25TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73129-4843
Mailing Address - Country:US
Mailing Address - Phone:405-636-1463
Mailing Address - Fax:405-635-8417
Practice Address - Street 1:744 SE 25TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73129-4843
Practice Address - Country:US
Practice Address - Phone:405-636-1463
Practice Address - Fax:405-635-8417
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4423101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional