Provider Demographics
NPI:1316098734
Name:ELISENS, MERRIE MICHAL (PHD)
Entity type:Individual
Prefix:DR
First Name:MERRIE
Middle Name:MICHAL
Last Name:ELISENS
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:2420 SPRINGER DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-3965
Mailing Address - Country:US
Mailing Address - Phone:405-329-8454
Mailing Address - Fax:405-360-8193
Practice Address - Street 1:222 OLIPHANT AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73026-3701
Practice Address - Country:US
Practice Address - Phone:405-329-8454
Practice Address - Fax:405-360-8193
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2017-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK833103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100837710-AMedicaid
OK189327OtherTRICARE
OK100837710-AMedicaid