1356198246 NPI number — KAREN CATHERINE CLIFFORD BROYLES CANDIDATE FOR LPC

Table of content: KAREN CATHERINE CLIFFORD BROYLES CANDIDATE FOR LPC (NPI 1356198246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356198246 NPI number — KAREN CATHERINE CLIFFORD BROYLES CANDIDATE FOR LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROYLES
Provider First Name:
KAREN CATHERINE
Provider Middle Name:
CLIFFORD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CANDIDATE FOR LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLIFFORD
Provider Other First Name:
K.C.
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CANDIDATE FOR LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1356198246
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 NW 17TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73103-2113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-210-1852
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 W WILSHIRE BLVD STE C3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73116-9050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-210-1852
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/30/2024

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: 101YP2500X , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com