Provider Demographics
NPI:1639108806
Name:BUTCHKO, KAY CANDACE (MS)
Entity type:Individual
Prefix:MS
First Name:KAY
Middle Name:CANDACE
Last Name:BUTCHKO
Suffix:
Gender:F
Credentials:MS
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 52778
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74152-0778
Mailing Address - Country:US
Mailing Address - Phone:918-295-0202
Mailing Address - Fax:918-599-7099
Practice Address - Street 1:1536 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-6202
Practice Address - Country:US
Practice Address - Phone:918-295-0202
Practice Address - Fax:918-599-7099
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK266106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist