MICHAEL BRUCE ETZLER (NPI# 1104163773) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104163773 |
| Entity Type | Individual |
| Full Name | MICHAEL BRUCE ETZLER |
| Practice Address |
3317 E Memorial Rd Ste 101 Edmond OK 73013-7105 |
| Mailing Address |
3905 Spring Hill Dr Edmond OK 73013-6929 |
| Practice Telephone | 4054765826 |
| Mailing Telephone | 4054765826 |
| Enumeration Date | 2013-01-15 |
| Last Update Date | 2013-01-15 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| Street Address |
3317 E MEMORIAL RD STE 101 |
| City | EDMOND |
| State | OK |
| Zip Code | 73013-7105 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417910266 | Holly Lea Jones | Physical Therapist | 3317 E Memorial Rd, Suite 104, Edmond, OK 73013-7105 | 2006-04-11 |
| 1134143480 | Amy Catherine Reid | Physical Therapist | 3317 E Memorial Rd, Edmond, OK 73013-7095 | 2006-07-27 |
| 1457387102 | Hj Enterprises | Physical Therapist | 3317 E Memorial Rd, Suite 104, Edmond, OK 73013-7095 | 2006-06-24 |
| 1083663611 | Susan M Dimick | Family Medicine | 3317 E Memorial Rd, Suite 103, Edmond, OK 73013-7105 | 2006-05-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407461866 | Alison Church-pugh | Case Manager/Care Coordinator | 1441 Kelley Pointe Pkwy, Edmond, OK 73013 | 2020-09-12 |
| 1699395343 | Dental Specialists of Edmond | Dentist | 16430 Muirfield Pl, Edmond, OK 73013 | 2020-04-23 |
| 1104477215 | Kammerer Richey LLC | Nurse Practitioner | 902 Nw 139th Street Parway, Edmond, OK 73013 | 2019-09-20 |
| 1811459191 | Peak Movement Centre, Pllc | Clinic/Center | 13816 Santa Fe Crossing Dr, Edmond, OK 73013 | 2019-04-04 |
| 1851858492 | Luma Hilal | Pharmacist | 2228 Nw 15th Terrace, Edmond, OK 73013 | 2019-03-01 |
| 1578031571 | Oklahoma Wellness Group LLC | Internal Medicine | 14101 North Esatern Avenue Suite B, Edmond, OK 73013 | 2018-11-07 |
| 1477034395 | Specialty Care Pediatrics, Inc. | Home Health | 2256 Nw 164th Street, Edmond, OK 73013 | 2018-08-28 |
| 1972083921 | Pooja Bhakta | Physician Assistant | Stanbro Healthcare Group LLC, 2000 E. 15th St., Suite 400-a, Edmond, OK 73013 | 2018-08-20 |
| 1417460577 | Oklahoma Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 15103 N Macarthur Blvd, Oklahoma City, OK 73013 | 2017-11-13 |
| 1356879753 | Shawn Smith Optimal Pt and Performance, Pllc | Physical Therapist | 336 Ne 145th Pl, Edmond, OK 73013 | 2017-05-30 |
| Find all providers in zip 73013 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962013912 | Ashley Lambert | Counselor | 19501 N Pennsylvia, Apt 210, Edmond, OK 73012 | 2020-08-13 |
| 1467070565 | Kelsey Hines | Counselor | 2000 E 15th St Ste 450c, Edmond, OK 73013-6670 | 2020-07-06 |
| 1063039568 | Amber Nicole Aranda | Counselor | 2501 Glen Hollow Rd, Edmond, OK 73034-4279 | 2020-06-30 |
| 1407473234 | Mary Tidwell | Counselor | 525 Liberty Ln, Edmond, OK 73034-9046 | 2020-06-27 |
| 1326676610 | Melissa Mendez | Counselor | 2716 Nw 189th St, Edmond, OK 73012-0015 | 2020-03-31 |
| 1407490048 | Leslie Burnside | Counselor | 600 N Blackwelder Ave Apt 24, Edmond, OK 73034-5167 | 2019-11-06 |
| 1033689203 | Charles Watson Robinson IIi | Counselor | 1401 Nw 150th St Ste B, Edmond, OK 73013-2169 | 2018-11-30 |
| 1801362983 | Ida Moore | Counselor | 16224 Everglade Ln, Edmond, OK 73013-1259 | 2018-10-16 |
| 1538662952 | Josiah Stogsdill | Counselor | 307 E Danforth Rd Ste 124, Edmond, OK 73034-4484 | 2018-03-12 |
| 1356861538 | Mackenzie O'mealey | Counselor | 425 S Fretz Ave Ste C, Edmond, OK 73003-5568 | 2017-06-20 |
| Find all providers in EDMOND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.