Provider Demographics
NPI:1770854648
Name:CULIE, RONNIE SUE (MED)
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:SUE
Last Name:CULIE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 W OKMULGEE ST
Mailing Address - Street 2:STE.M
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-6749
Mailing Address - Country:US
Mailing Address - Phone:918-681-4944
Mailing Address - Fax:918-681-4990
Practice Address - Street 1:1601 W OKMULGEE ST
Practice Address - Street 2:STE M
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-6749
Practice Address - Country:US
Practice Address - Phone:918-681-4944
Practice Address - Fax:918-681-4990
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor