Provider Demographics
NPI:1265836282
Name:CORLEY, EMILY REBEKAH (PHD, BA, MS)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:REBEKAH
Last Name:CORLEY
Suffix:
Gender:F
Credentials:PHD, BA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 PALMER CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6351
Mailing Address - Country:US
Mailing Address - Phone:405-561-7928
Mailing Address - Fax:405-310-9944
Practice Address - Street 1:2405 PALMER CIR STE 100
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6351
Practice Address - Country:US
Practice Address - Phone:405-561-7928
Practice Address - Fax:405-310-9944
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1322103TC0700X
103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200801350AMedicaid