Provider Demographics
NPI:1740501626
Name:FAULKNER, CORENE G
Entity type:Individual
Prefix:MRS
First Name:CORENE
Middle Name:G
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CORENE
Other - Middle Name:G
Other - Last Name:MCVEIGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 401
Mailing Address - Street 2:
Mailing Address - City:OKEMAH
Mailing Address - State:OK
Mailing Address - Zip Code:74859-0401
Mailing Address - Country:US
Mailing Address - Phone:918-623-0373
Mailing Address - Fax:
Practice Address - Street 1:1102 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:OKEMAH
Practice Address - State:OK
Practice Address - Zip Code:74859-2220
Practice Address - Country:US
Practice Address - Phone:918-623-0373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor