Provider Demographics
NPI:1578882528
Name:ELLIOTT, KARLA LEA
Entity Type:Individual
Prefix:MRS
First Name:KARLA
Middle Name:LEA
Last Name:ELLIOTT
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:PO BOX 795
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-0795
Mailing Address - Country:US
Mailing Address - Phone:580-298-3361
Mailing Address - Fax:580-298-2129
Practice Address - Street 1:1009 SE 3RD ST
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-4239
Practice Address - Country:US
Practice Address - Phone:580-298-3361
Practice Address - Fax:580-298-2129
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor