Provider Demographics
NPI:1982951810
Name:FREDERICK, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:FREDERICK
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 1:1228 NE 42ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-5845
Mailing Address - Country:US
Mailing Address - Phone:405-821-9465
Mailing Address - Fax:
Practice Address - Street 1:1301 N MARTIN LUTHER KING AVE
Practice Address - Street 2:STE#101
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-4235
Practice Address - Country:US
Practice Address - Phone:405-424-0007
Practice Address - Fax:405-424-6507
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health