Provider Demographics
NPI:1750049607
Name:ROYLANCE, MADISON
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:ROYLANCE
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 1:4101 N CLASSEN BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-2413
Mailing Address - Country:US
Mailing Address - Phone:801-628-3584
Mailing Address - Fax:
Practice Address - Street 1:4101 N CLASSEN BLVD STE D
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-2413
Practice Address - Country:US
Practice Address - Phone:801-628-3584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health