Healthcare Provider Details

I. General information

NPI: 1487735296
Provider Name (Legal Business Name): REBECCA LYNNE KROEKER M.H.R., L.P.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 W OWEN K GARRIOTT RD SUITE F
ENID OK
73703-5653
US

IV. Provider business mailing address

2515 EDGEWOOD DR
ENID OK
73703-1541
US

V. Phone/Fax

Practice location:
  • Phone: 580-242-4673
  • Fax: 580-242-4679
Mailing address:
  • Phone: 580-234-6781
  • Fax: 580-242-4679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3668
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: