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General NPI Number Information
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NPI Number | 1811863079
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Entity Type | Individual
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Provider Name | CAROLEE BRYAN
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Gender | Female
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Dates
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Enumeration Date | 10/15/2025
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 1516 S BOSTON AVE STE 105
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City | TULSA
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State | OK
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Zip | 74119-4003
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Country | US
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Telephone | 918-698-4129
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Fax | 539-664-9822
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Provider Business Mailing Address
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Address Line | 1013 N HICKORY DR
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City | BROKEN ARROW
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State | OK
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Zip | 74012-1628
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Country | US
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Telephone | 918-583-5588
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Fax | 539-664-9822
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | ODMHSAS
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License Number State | OK
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