Provider Demographics
NPI:1437419629
Name:ADKISM, CARLIN SHAY
Entity type:Individual
Prefix:
First Name:CARLIN
Middle Name:SHAY
Last Name:ADKISM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 E 54TH PL N
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74126-2736
Mailing Address - Country:US
Mailing Address - Phone:918-269-1449
Mailing Address - Fax:
Practice Address - Street 1:723 E 54TH PL N
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74126-2736
Practice Address - Country:US
Practice Address - Phone:918-269-1449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst