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General NPI Number Information
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NPI Number | 1417273293
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Entity Type | Individual
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Provider Name | KIMBERLY D YOUNG-COLLOGAN
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Gender | Female
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Dates
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Enumeration Date | 04/19/2010
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 11740 E 21ST ST
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City | TULSA
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State | OK
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Zip | 74129-1820
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Country | US
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Telephone | 918-437-9495
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Fax |
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Provider Business Mailing Address
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Address Line | 17824 E SUNSET RDG
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City | OWASSO
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State | OK
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Zip | 74055-7581
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Country | US
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Telephone | 580-352-4152
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5292
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License Number State | OK
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