Michael E. Connella
Individual provider Active NPI Counselor · Talala, OK
NPI 1285953091 · NPPES record last updated May 19, 2010
Key facts
- NPI
- 1285953091
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 10756 E Fawn LN
Talala, OK 74080-9444 - Phone
- (918) 261-1201
- NPI assigned
- May 19, 2010
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
10756 E Fawn LN
Talala, OK 74080-9444
Mailing address
10756 E Fawn LN
Talala, OK 74080-9444
Other providers in Talala, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.