Provider Demographics
NPI:1306482542
Name:CUFFY, KRASHELLE RENAE
Entity type:Individual
Prefix:MRS
First Name:KRASHELLE
Middle Name:RENAE
Last Name:CUFFY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31609 E 64TH ST S
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-8583
Mailing Address - Country:US
Mailing Address - Phone:786-520-1353
Mailing Address - Fax:
Practice Address - Street 1:2035 W HOUSTON ST STE A
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8792
Practice Address - Country:US
Practice Address - Phone:918-324-4803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-22
Last Update Date:2024-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200877070AMedicaid