Healthcare Provider Details

I. General information

NPI: 1053173633
Provider Name (Legal Business Name): DARBY KATE SEWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 24TH AVE NW
NORMAN OK
73069-6369
US

IV. Provider business mailing address

3105 MONTANE DR
NORMAN OK
73069-6988
US

V. Phone/Fax

Practice location:
  • Phone: 405-310-3262
  • Fax:
Mailing address:
  • Phone: 405-473-4094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: