=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083966576
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAYLA PLANK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2012
-----------------------------------------------------
Last Update Date | 10/08/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 204 E CHOCTAW
-----------------------------------------------------
City | SALLISAW
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-790-2292
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 473101 E 1127 RD
-----------------------------------------------------
City | MULDROW
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------