Healthcare Provider Details

I. General information

NPI: 1245241223
Provider Name (Legal Business Name): KIMBERLY ANN QUINTERO M.S., L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 W A ST
WATONGA OK
73772-4208
US

IV. Provider business mailing address

RR 1 BOX 68
WEATHERFORD OK
73096-9709
US

V. Phone/Fax

Practice location:
  • Phone: 580-623-7199
  • Fax:
Mailing address:
  • Phone: 580-772-6833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2042
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: