Provider Demographics
NPI:1457572257
Name:COVINGTON, MIKE (LPC, LADC)
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:
Last Name:COVINGTON
Suffix:
Gender:M
Credentials:LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-3800
Mailing Address - Country:US
Mailing Address - Phone:405-826-4867
Mailing Address - Fax:
Practice Address - Street 1:425 S FRETZ AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-5532
Practice Address - Country:US
Practice Address - Phone:405-726-9808
Practice Address - Fax:405-726-9809
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK536101YA0400X
OK3610101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK12593360OtherCAQH
OK200379200AMedicaid