Healthcare Provider Details

I. General information

NPI: 1982968723
Provider Name (Legal Business Name): KIM A HUKILL MS, LPC CANIDATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

946 E ELM ST
ALTUS OK
73521-4026
US

IV. Provider business mailing address

946 E ELM ST
ALTUS OK
73521-4026
US

V. Phone/Fax

Practice location:
  • Phone: 580-471-2406
  • Fax:
Mailing address:
  • Phone: 580-471-2406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: