Healthcare Provider Details

I. General information

NPI: 1861084584
Provider Name (Legal Business Name): KYLEA CAUGHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3124 E APACHE ST
TULSA OK
74110-2320
US

IV. Provider business mailing address

2346 S 104TH EAST AVE
TULSA OK
74129-4653
US

V. Phone/Fax

Practice location:
  • Phone: 918-743-5763
  • Fax:
Mailing address:
  • Phone: 918-998-6649
  • 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: