Healthcare Provider Details

I. General information

NPI: 1871824557
Provider Name (Legal Business Name): KIMBERLY KAY HOUSE LPC, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 SW 30TH CT
MOORE OK
73160-2887
US

IV. Provider business mailing address

1105 SW 30TH CT
MOORE OK
73160-2887
US

V. Phone/Fax

Practice location:
  • Phone: 405-378-2727
  • Fax:
Mailing address:
  • Phone: 405-378-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number551
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5994
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: