Provider Demographics
NPI:1356198246
Name:BROYLES, KAREN CATHERINE CLIFFORD (CANDIDATE FOR LPC)
Entity type:Individual
Prefix:
First Name:KAREN CATHERINE
Middle Name:CLIFFORD
Last Name:BROYLES
Suffix:
Gender:F
Credentials:CANDIDATE FOR LPC
Other - Prefix:
Other - First Name:K.C.
Other - Middle Name:
Other - Last Name:CLIFFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CANDIDATE FOR LPC
Mailing Address - Street 1:501 NW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2113
Mailing Address - Country:US
Mailing Address - Phone:405-210-1852
Mailing Address - Fax:
Practice Address - Street 1:100 W WILSHIRE BLVD STE C3
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-9050
Practice Address - Country:US
Practice Address - Phone:405-210-1852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional