Provider Demographics
NPI:1407345879
Name:MCPHAIL, KYLIE JO (LMSW-P)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:JO
Last Name:MCPHAIL
Suffix:
Gender:F
Credentials:LMSW-P
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:JO
Other - Last Name:DETHERAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW-P
Mailing Address - Street 1:2548 E KENOSHA ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-6712
Mailing Address - Country:US
Mailing Address - Phone:918-382-7300
Mailing Address - Fax:
Practice Address - Street 1:650 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-4429
Practice Address - Country:US
Practice Address - Phone:918-587-9471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker