Provider Demographics
NPI:1881973006
Name:MIGL, CARLY ELIZABETH
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:ELIZABETH
Last Name:MIGL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-2816
Mailing Address - Country:US
Mailing Address - Phone:918-224-0225
Mailing Address - Fax:918-224-5975
Practice Address - Street 1:2 N WATER ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-2816
Practice Address - Country:US
Practice Address - Phone:918-224-0225
Practice Address - Fax:918-224-5975
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No172V00000XOther Service ProvidersCommunity Health Worker