Healthcare Provider Details

I. General information

NPI: 1699887265
Provider Name (Legal Business Name): KATHRYN A COLLIER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHYRN A COLLIER LCSW

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 W 3RD ST
ELK CITY OK
73644-4323
US

IV. Provider business mailing address

820 N COOK ST
CORDELL OK
73632-3004
US

V. Phone/Fax

Practice location:
  • Phone: 580-225-5136
  • Fax:
Mailing address:
  • Phone: 580-832-5275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI-05723
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4605
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: