Provider Demographics
NPI:1356888085
Name:FITZPATRICK, MICHAELA (LCSW)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:
Other - Last Name:DIEDRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4200 NE 32ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73121-6602
Mailing Address - Country:US
Mailing Address - Phone:580-747-2220
Mailing Address - Fax:
Practice Address - Street 1:4200 NE 32ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73121-6602
Practice Address - Country:US
Practice Address - Phone:580-747-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health