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NPI Code Detail

MEDICARE: LILLIE KENNER

MEDICARE: LILLIE KENNER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorLPC 157OK

General Provider Information

NPI Number : 1912121765
Entity Type Code : Individual
Provider Name (Legal Business Name) : LILLIE KENNER
Provider Business Mailing Address
First Line : 1222 10TH ST STE 211
Second Line :
City : WOODWARD
State : OK
Zip : 73801-3156
Country : US
Telephone Number : 580-234-3791
Fax Number : 580-237-7711
Provider Business Practice Location Address
First Line : 702 N GRAND ST
Second Line :
City : ENID
State : OK
Zip : 73701-3221
Country : US
Telephone Number : 580-234-3791
Fax Number : 580-237-7711
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2007
Last Update Date : 07/08/2007

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Directions to “ LILLIE KENNER ” Practice Location

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