Individual
MR. MIKE COVINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC, LADC
Contact information
Practice address
425 S FRETZ AVE, EDMOND, OK 73003-5532
(405) 726-9808
(405) 726-9809
Mailing address
1512 GEORGE ST, EDMOND, OK 73003-3800
(405) 826-4867
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
3610
OK
101YA0400X
Addiction (Substance Use Disorder) Counselor
536
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12593360
CAQH
OK
05
—
200379200A
—
OK
Enumeration date
05/01/2007
Last updated
03/17/2018
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