Provider Demographics
NPI:1841096922
Name:KALLAS, KLAIRE
Entity type:Individual
Prefix:
First Name:KLAIRE
Middle Name:
Last Name:KALLAS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KLAIRE
Other - Middle Name:
Other - Last Name:HOPKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:230 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-4012
Mailing Address - Country:US
Mailing Address - Phone:580-242-5544
Mailing Address - Fax:
Practice Address - Street 1:230 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-4012
Practice Address - Country:US
Practice Address - Phone:580-242-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLPCCANDIDATE12685101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health