Healthcare Provider Details

I. General information

NPI: 1407211402
Provider Name (Legal Business Name): KENDRA MATHIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENDRA DAY LPC

II. Dates (important events)

Enumeration Date: 12/18/2015
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 W UNIVERSITY BLVD STE 102
DURANT OK
74701-2970
US

IV. Provider business mailing address

107 S HIGH ST
ANTLERS OK
74523-3818
US

V. Phone/Fax

Practice location:
  • Phone: 580-924-7330
  • Fax: 580-924-7334
Mailing address:
  • Phone: 580-298-2830
  • Fax: 580-298-6723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: