Provider Demographics
NPI:1649482761
Name:MCAULIFFE, CARLA J (MA, LPC, LADC)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:J
Last Name:MCAULIFFE
Suffix:
Gender:F
Credentials:MA, LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 N. BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044
Mailing Address - Country:US
Mailing Address - Phone:405-863-8854
Mailing Address - Fax:
Practice Address - Street 1:1251 N. BROADWAY
Practice Address - Street 2:SUITE C
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034
Practice Address - Country:US
Practice Address - Phone:405-341-3554
Practice Address - Fax:405-341-3511
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3574101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional