Provider Demographics
NPI:1780804161
Name:TAYLOR, KAREN LAN (CM-D,BA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LAN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CM-D,BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20496 E 48TH ST S
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-5246
Mailing Address - Country:US
Mailing Address - Phone:918-906-6434
Mailing Address - Fax:918-227-1125
Practice Address - Street 1:15 E DEWEY AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-4201
Practice Address - Country:US
Practice Address - Phone:918-227-2016
Practice Address - Fax:918-227-1125
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor