Healthcare Provider Details

I. General information

NPI: 1114069747
Provider Name (Legal Business Name): KATHY JO LOEHR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S GARNETT RD
TULSA OK
74128-1805
US

IV. Provider business mailing address

4827 W 87TH ST
TULSA OK
74132-3458
US

V. Phone/Fax

Practice location:
  • Phone: 918-438-4257
  • Fax:
Mailing address:
  • Phone: 918-853-2743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4108
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number812
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: