Provider Demographics
NPI:1770852717
Name:KISER, KARYLL LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:KARYLL
Middle Name:LYNN
Last Name:KISER
Suffix:
Gender:F
Credentials:LPC
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 30893
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-0015
Mailing Address - Country:US
Mailing Address - Phone:405-341-0036
Mailing Address - Fax:
Practice Address - Street 1:2713 PENNINGTON AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-6562
Practice Address - Country:US
Practice Address - Phone:405-341-0036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1718101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health