Provider Demographics
NPI:1407979750
Name:KILLIAN-YOUNG, CHARLA GAYLE (MSW)
Entity Type:Individual
Prefix:
First Name:CHARLA
Middle Name:GAYLE
Last Name:KILLIAN-YOUNG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 N SHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6625
Mailing Address - Country:US
Mailing Address - Phone:405-436-3686
Mailing Address - Fax:
Practice Address - Street 1:900 E. MAIN STR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73070
Practice Address - Country:US
Practice Address - Phone:405-573-8232
Practice Address - Fax:405-573-6650
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK58301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program