MEDICARE: MOLLIE LYNN CARTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1518815802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLIE LYNN CARTER

Provider Business Mailing Address
First Line	:	221 NORTH ST
Second Line	:
City	:	TAHLEQUAH
State	:	OK
Zip	:	74464-6912
Country	:	US
Telephone Number	:	539-367-1534
Fax Number	:

Provider Business Practice Location Address
First Line	:	721 W QUEENS ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-1767
Country	:	US
Telephone Number	:	539-367-1534
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	03/20/2026

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Directions to “ MOLLIE LYNN CARTER ” Practice Location

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