Provider Demographics
NPI:1528138369
Name:GOEBEL, KAY (PH D)
Entity type:Individual
Prefix:DR
First Name:KAY
Middle Name:
Last Name:GOEBEL
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 NW 63RD ST.
Mailing Address - Street 2:SUITE 303
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-6511
Mailing Address - Country:US
Mailing Address - Phone:405-843-1998
Mailing Address - Fax:405-843-8292
Practice Address - Street 1:1140 NW 63RD ST
Practice Address - Street 2:SUITE 303
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-6552
Practice Address - Country:US
Practice Address - Phone:405-843-1998
Practice Address - Fax:405-843-8292
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK155103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist