Healthcare Provider Details

I. General information

NPI: 1831468230
Provider Name (Legal Business Name): TRACEY LEE MCLAUGHLIN BCND, CNC, CHS, MH,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 AVONDALE DR SUITE 200
NICHOLS HILLS OK
73116-6421
US

IV. Provider business mailing address

6440 AVONDALE DR SUITE 200
NICHOLS HILLS OK
73116-6421
US

V. Phone/Fax

Practice location:
  • Phone: 405-409-5742
  • Fax: 405-254-5574
Mailing address:
  • Phone: 405-409-5742
  • Fax: 405-254-5574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number81246
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: