Healthcare Provider Details

I. General information

NPI: 1235685587
Provider Name (Legal Business Name): KIRSTYN PLYMALE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 HIGHWAY 70 E STE B
KINGSTON OK
73439-8253
US

IV. Provider business mailing address

204 N 7TH ST APT 204B
CALERA OK
74730-1505
US

V. Phone/Fax

Practice location:
  • Phone: 580-795-3794
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number12230
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: