Healthcare Provider Details

I. General information

NPI: 1821635194
Provider Name (Legal Business Name): CHELSEY TAYLOR TEMPLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E 12TH ST
ADA OK
74820-6508
US

IV. Provider business mailing address

230 E 12TH ST
ADA OK
74820-6508
US

V. Phone/Fax

Practice location:
  • Phone: 580-332-3001
  • Fax: 580-322-8774
Mailing address:
  • Phone: 580-332-3001
  • Fax: 580-322-8774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10546
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: