Provider Demographics
NPI:1831437433
Name:SALOUS, ANDREW LEE
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:LEE
Last Name:SALOUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10509 WATERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-2529
Mailing Address - Country:US
Mailing Address - Phone:405-735-6088
Mailing Address - Fax:
Practice Address - Street 1:10509 WATERSIDE DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-2529
Practice Address - Country:US
Practice Address - Phone:405-735-6088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)