Provider Demographics
NPI:1487676557
Name:MANES, MICHAEL LINDSEY (MS, LPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LINDSEY
Last Name:MANES
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21228
Mailing Address - Street 2:DEPARTMENT 31
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74121-1228
Mailing Address - Country:US
Mailing Address - Phone:918-491-3700
Mailing Address - Fax:
Practice Address - Street 1:6655 S YALE AVE
Practice Address - Street 2:LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3326
Practice Address - Country:US
Practice Address - Phone:918-491-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY818101YP2500X
OK4269101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional