Provider Demographics
NPI:1104104702
Name:SULLIVAN, KARLA KIMBERLEY (MCP, LPC)
Entity type:Individual
Prefix:MRS
First Name:KARLA
Middle Name:KIMBERLEY
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MCP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 N TAFT ST
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-4001
Mailing Address - Country:US
Mailing Address - Phone:580-548-3953
Mailing Address - Fax:
Practice Address - Street 1:222 N TAFT ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-4001
Practice Address - Country:US
Practice Address - Phone:580-548-3953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-30
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4530101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional