Provider Demographics
NPI:1124138086
Name:MCCARTY, KAYE EILEEN ROSS (MED LPC NCC)
Entity type:Individual
Prefix:MRS
First Name:KAYE
Middle Name:EILEEN ROSS
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:MED LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W 8TH
Mailing Address - Street 2:
Mailing Address - City:NEWKIRK
Mailing Address - State:OK
Mailing Address - Zip Code:74647
Mailing Address - Country:US
Mailing Address - Phone:580-362-3913
Mailing Address - Fax:580-762-3088
Practice Address - Street 1:419 FAIRVIEW AVE
Practice Address - Street 2:STE 2
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1923
Practice Address - Country:US
Practice Address - Phone:580-762-8367
Practice Address - Fax:580-762-3088
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional