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General NPI Number Information
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NPI Number | 1528127388
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Entity Type | Individual
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Provider Name | CAROL ELLISE O'BRYAN LMFT
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Gender | Female
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Dates
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Enumeration Date | 12/07/2006
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Last Update Date | 06/27/2012
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Provider Practice Location Address
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Address Line | 301 S POPLAR AVE
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City | BROKEN ARROW
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State | OK
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Zip | 74012-8396
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Country | US
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Telephone | 918-251-1662
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Fax |
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Provider Business Mailing Address
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Address Line | 201 S GARNETT RD
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City | TULSA
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State | OK
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Zip | 74128-1805
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Country | US
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Telephone | 918-438-4257
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 895
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2007002866
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2006029726
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4025
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License Number State | OK
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Taxonomy #5
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 798
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License Number State | TN
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