Provider Demographics
NPI:1124504857
Name:HILL, CARLY ANNE (MA)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:ANNE
Last Name:HILL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:ANN
Other - Last Name:PENNINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1135 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4120
Mailing Address - Country:US
Mailing Address - Phone:918-814-1165
Mailing Address - Fax:
Practice Address - Street 1:650 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-4429
Practice Address - Country:US
Practice Address - Phone:918-587-9471
Practice Address - Fax:918-560-1399
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor