Healthcare Provider Details

I. General information

NPI: 1902952997
Provider Name (Legal Business Name): KULWADEE 'LEE' ACERS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 NW 21ST ST
OKLAHOMA CITY OK
73103-1810
US

IV. Provider business mailing address

616 NW 21ST ST
OKLAHOMA CITY OK
73103-1810
US

V. Phone/Fax

Practice location:
  • Phone: 405-528-7721
  • Fax: 405-528-7731
Mailing address:
  • Phone: 405-528-7721
  • Fax: 405-528-7731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3245
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: