Healthcare Provider Details

I. General information

NPI: 1568533743
Provider Name (Legal Business Name): KATHY ANN BILLIPS MS, LBP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 S ELM PL
BROKEN ARROW OK
74012-5369
US

IV. Provider business mailing address

25211 E 64TH ST S
BROKEN ARROW OK
74014-2214
US

V. Phone/Fax

Practice location:
  • Phone: 918-812-5315
  • Fax:
Mailing address:
  • Phone: 918-812-5315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0257
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: