Healthcare Provider Details

I. General information

NPI: 1497123798
Provider Name (Legal Business Name): STEVEN KYLE TOELLE MS, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 NE 50TH STREET CHOCTAW
UNITED STATES OK
73020
US

IV. Provider business mailing address

14700 NE 50TH STREET CHOCTAW
UNITED STATES OK
73020
US

V. Phone/Fax

Practice location:
  • Phone: 580-660-0446
  • Fax:
Mailing address:
  • Phone: 580-660-0446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6604
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: