Provider Demographics
NPI:1669712766
Name:SABOLICH, MAIKE (BA)
Entity type:Individual
Prefix:MRS
First Name:MAIKE
Middle Name:
Last Name:SABOLICH
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 N DONALD AVE
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-5941
Mailing Address - Country:US
Mailing Address - Phone:405-532-5016
Mailing Address - Fax:
Practice Address - Street 1:4400 WILL ROGERS PKWY
Practice Address - Street 2:SUITE 214
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-1837
Practice Address - Country:US
Practice Address - Phone:405-601-8876
Practice Address - Fax:405-601-7358
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst