Healthcare Provider Details

I. General information

NPI: 1336054741
Provider Name (Legal Business Name): KACIA AUDRA-LYNN MARSHALL LPC-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 S TRENTON AVE
TULSA OK
74120-5420
US

IV. Provider business mailing address

1239 S TRENTON AVE
TULSA OK
74120-5420
US

V. Phone/Fax

Practice location:
  • Phone: 918-588-8888
  • Fax:
Mailing address:
  • Phone: 918-588-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13414
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: