Provider Demographics
NPI:1104163773
Name:ETZLER, MICHAEL BRUCE
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRUCE
Last Name:ETZLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6929
Mailing Address - Country:US
Mailing Address - Phone:405-476-5826
Mailing Address - Fax:
Practice Address - Street 1:1218 E 9TH ST STE 4
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5796
Practice Address - Country:US
Practice Address - Phone:405-476-5826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health