MEDICARE: KALLIE ORLIK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1063967545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALLIE ORLIK

Provider Business Mailing Address
First Line	:	136 LANDON DR
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-1334
Country	:	US
Telephone Number	:	405-938-8654
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 S FRETZ AVE
Second Line	:	SUITE C
City	:	EDMOND
State	:	OK
Zip	:	73003-5570
Country	:	US
Telephone Number	:	405-726-9808
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2016
Last Update Date	:	08/24/2016

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Directions to “ KALLIE ORLIK ” Practice Location

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