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General NPI Number Information
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NPI Number | 1629552971
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Entity Type | Organization
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Legal Business Name | CAROLE'S HOPE
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Dates
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Enumeration Date | 09/22/2018
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Last Update Date | 09/22/2018
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Provider Practice Location Address
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Address Line | 7711 E 111TH ST STE 116
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City | TULSA
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State | OK
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Zip | 74133-2563
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Country | US
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Telephone | 918-261-4055
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Fax | 918-528-5058
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Provider Business Mailing Address
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Address Line | 10414 S TOLEDO AVE
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City | TULSA
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State | OK
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Zip | 74137-6245
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Country | US
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Telephone | 918-261-4055
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Fax | 918-528-5058
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Authorized Official
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Title or Position | OWNER
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Name | SHONN R. BROYLES
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Credential | LPC
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Telephone | 918-261-4055
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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 |
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License Number State |
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