Provider Demographics
NPI:1033437348
Name:TRUMBULL, KARLA DENISE
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:DENISE
Last Name:TRUMBULL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:DENISE
Other - Last Name:TRUMBULL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS IN ELEMENTARY ED
Mailing Address - Street 1:201 S WYNDEMERE LAKES DR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-8139
Mailing Address - Country:US
Mailing Address - Phone:405-793-9435
Mailing Address - Fax:
Practice Address - Street 1:201 S WYNDEMERE LAKES DR
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-8139
Practice Address - Country:US
Practice Address - Phone:405-793-9435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor