Provider Demographics
NPI:1730222910
Name:BAZIN, KATHERINE MICHELENE (MHR)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:MICHELENE
Last Name:BAZIN
Suffix:
Gender:F
Credentials:MHR
Other - Prefix:MRS
Other - First Name:KATHERINE
Other - Middle Name:MICHELENE
Other - Last Name:KRAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHR
Mailing Address - Street 1:808 S PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-4427
Mailing Address - Country:US
Mailing Address - Phone:918-560-1300
Mailing Address - Fax:
Practice Address - Street 1:808 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-4427
Practice Address - Country:US
Practice Address - Phone:918-560-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK323101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)