Provider Demographics
NPI:1215977715
Name:DAUGHERTY, KARLEEN TALLEY (MSW)
Entity type:Individual
Prefix:
First Name:KARLEEN
Middle Name:TALLEY
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860A COPPERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-4147
Mailing Address - Country:US
Mailing Address - Phone:405-364-6233
Mailing Address - Fax:405-321-8381
Practice Address - Street 1:3750 W MAIN ST STE AA
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4663
Practice Address - Country:US
Practice Address - Phone:405-364-6233
Practice Address - Fax:405-701-5421
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100717330AMedicaid
OK100717330AMedicaid
OK$$$$$$$$$Medicare PIN