Healthcare Provider Details

I. General information

NPI: 1790931566
Provider Name (Legal Business Name): KEITH CARNELL MORTON L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N LEE AVE
OKLAHOMA CITY OK
73102-1036
US

IV. Provider business mailing address

1000 N LEE AVE
OKLAHOMA CITY OK
73102-1036
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-4955
  • Fax: 405-270-7576
Mailing address:
  • Phone: 405-272-4955
  • Fax: 405-270-7576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4037
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: