1235469800 NPI number — MR. WILLIAM HENRY MUKES JR. LMFT

Table of content: MR. WILLIAM HENRY MUKES JR. LMFT (NPI 1235469800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235469800 NPI number — MR. WILLIAM HENRY MUKES JR. LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUKES
Provider First Name:
WILLIAM
Provider Middle Name:
HENRY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
LMFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235469800
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 S. BROADWAY ST BLDG 100
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73013-4038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-990-1907
Provider Business Mailing Address Fax Number:
405-241-5221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 S BROADWAY STE 100
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
EDMOND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73013-4039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-990-1907
Provider Business Practice Location Address Fax Number:
405-241-5221
Provider Enumeration Date:
01/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  1041 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 1158 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200378070A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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