Provider Demographics
NPI:1275816803
Name:PAGE, KAREN K
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:K
Last Name:PAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4506 E AVERY ANN RD
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:OK
Mailing Address - Zip Code:74032-1367
Mailing Address - Country:US
Mailing Address - Phone:918-332-0580
Mailing Address - Fax:
Practice Address - Street 1:4506 E AVERY ANN RD
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:OK
Practice Address - Zip Code:74032-1367
Practice Address - Country:US
Practice Address - Phone:918-332-0580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor