Individual
MR. KEVIN AUSTIN MICHAEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S.W.
Contact information
Practice address
1011 HONOR HEIGHTS DR, MUSKOGEE, OK 74401-1318
(407) 257-2870
Mailing address
PO BOX 754, COWETA, OK 74429-0754
(407) 257-2870
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104189489
—
OK
Enumeration date
06/21/2012
Last updated
06/21/2012
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