Provider Demographics
NPI:1437548930
Name:KORI ZIBELL PLLC
Entity Type:Organization
Organization Name:KORI ZIBELL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KORI
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIBELL
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:405-850-5860
Mailing Address - Street 1:2529 S KELLY AVE
Mailing Address - Street 2:C
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-2966
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:405-562-1975
Practice Address - Street 1:2529 S KELLY AVE
Practice Address - Street 2:C
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-2966
Practice Address - Country:US
Practice Address - Phone:405-850-5860
Practice Address - Fax:405-562-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1013101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200437270AMedicaid