Healthcare Provider Details

I. General information

NPI: 1083817563
Provider Name (Legal Business Name): CAROL K DILLARD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 12/28/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5512 S LEWIS AVE
TULSA OK
74105-7140
US

IV. Provider business mailing address

2503 E 19TH ST
TULSA OK
74104-5805
US

V. Phone/Fax

Practice location:
  • Phone: 918-749-7505
  • Fax:
Mailing address:
  • Phone: 918-749-5642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number968
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: