Provider Demographics
NPI:1861084584
Name:CAUGHMAN, KYLEA
Entity type:Individual
Prefix:
First Name:KYLEA
Middle Name:
Last Name:CAUGHMAN
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 1:20214 E ADMIRAL PL APT 724
Mailing Address - Street 2:
Mailing Address - City:CATOOSA
Mailing Address - State:OK
Mailing Address - Zip Code:74015-3264
Mailing Address - Country:US
Mailing Address - Phone:918-998-6649
Mailing Address - Fax:
Practice Address - Street 1:3124 E APACHE ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74110-2320
Practice Address - Country:US
Practice Address - Phone:918-743-5763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty