Provider Demographics
NPI:1013119809
Name:QUIROZ, MICHAEL WAYNE (MS, LPC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:QUIROZ
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 1:10906 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-5018
Mailing Address - Country:US
Mailing Address - Phone:918-833-0171
Mailing Address - Fax:
Practice Address - Street 1:10906 E 25TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-5018
Practice Address - Country:US
Practice Address - Phone:918-833-0171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK04600101YM0800X
OK10030101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health