Healthcare Provider Details

I. General information

NPI: 1053080705
Provider Name (Legal Business Name): CANDACE TELFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E 15TH ST STE B
EDMOND OK
73013-6610
US

IV. Provider business mailing address

9905 S PENNSYLVANIA AVE STE A
OKLAHOMA CITY OK
73159-6920
US

V. Phone/Fax

Practice location:
  • Phone: 405-548-1029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12420
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: