Healthcare Provider Details

I. General information

NPI: 1972725828
Provider Name (Legal Business Name): LARNA LOUISE TRIBBEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 WEST THIRD STREET
KONAWA OK
74849-0000
US

IV. Provider business mailing address

527 WEST THIRD STREET
KONAWA OK
74849-0000
US

V. Phone/Fax

Practice location:
  • Phone: 580-925-3286
  • Fax: 580-925-2362
Mailing address:
  • Phone: 580-925-3286
  • Fax: 580-925-2362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3554
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: