Provider Demographics
NPI:1841593936
Name:NORTON, MIKE
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:NORTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E MARSHALL DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-5332
Mailing Address - Country:US
Mailing Address - Phone:405-824-9284
Mailing Address - Fax:
Practice Address - Street 1:301 E MARSHALL DR
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-5332
Practice Address - Country:US
Practice Address - Phone:405-824-9284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$Medicaid