Provider Demographics
NPI:1831602507
Name:BACKORA, MICHAEL STEVEN
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STEVEN
Last Name:BACKORA
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 1:401 W. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:BARNSDALL
Mailing Address - State:OK
Mailing Address - Zip Code:74002-6631
Mailing Address - Country:US
Mailing Address - Phone:918-604-6054
Mailing Address - Fax:918-777-9018
Practice Address - Street 1:401 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:BARNSDALL
Practice Address - State:OK
Practice Address - Zip Code:74002-6631
Practice Address - Country:US
Practice Address - Phone:918-604-6054
Practice Address - Fax:918-777-9018
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health