Healthcare Provider Details

I. General information

NPI: 1306482542
Provider Name (Legal Business Name): MRS. KRASHELLE RENAE CUFFY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 W HOUSTON ST STE A
BROKEN ARROW OK
74012-8792
US

IV. Provider business mailing address

31609 E 64TH ST S
BROKEN ARROW OK
74014-8583
US

V. Phone/Fax

Practice location:
  • Phone: 918-324-4803
  • Fax:
Mailing address:
  • Phone: 786-520-1353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10331
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: