Provider Demographics
NPI:1013672880
Name:MEDLEY, MICHELE (FSP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:MEDLEY
Suffix:
Gender:F
Credentials:FSP
Other - Prefix:
Other - First Name:MICHI
Other - Middle Name:
Other - Last Name:MEDLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:14817 SLIPPERY FALLS CIR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-9712
Mailing Address - Country:US
Mailing Address - Phone:405-887-6243
Mailing Address - Fax:
Practice Address - Street 1:1120 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-5300
Practice Address - Country:US
Practice Address - Phone:405-360-5100
Practice Address - Fax:531-777-7579
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK106S00000X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician