Individual
MICHAEL RAY LAVINE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BHRS
Contact information
Practice address
2513 NW 115TH, OKC, OK 73120
(405) 206-0719
Mailing address
2513 NW 115TH, OKLAHOMA, OK 73120
(405) 206-0719
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
04/20/2012
Last updated
05/24/2012
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