Healthcare Provider Details

I. General information

NPI: 1629350996
Provider Name (Legal Business Name): KAYVRYELLE LATEASE HARMON B.A., A.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 N CLASSEN BLVD STE 214
OKLAHOMA CITY OK
73106-6834
US

IV. Provider business mailing address

214 SW 30TH ST
OKLAHOMA CITY OK
73109-6506
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-6710
  • Fax: 405-601-6711
Mailing address:
  • Phone: 405-272-1610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC05695
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: