Provider Demographics
NPI:1629666557
Name:MCCOLM, MICHELE K (LPC-CANDIDATE)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:K
Last Name:MCCOLM
Suffix:
Gender:F
Credentials:LPC-CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 H ST SE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-7908
Mailing Address - Country:US
Mailing Address - Phone:918-387-8720
Mailing Address - Fax:
Practice Address - Street 1:615 H ST SE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-7908
Practice Address - Country:US
Practice Address - Phone:918-387-8720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health