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General NPI Number Information
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NPI Number | 1114791241
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Entity Type | Individual
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Provider Name | TIARA DONN MCKENSIE KRUTA
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Gender | Female
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Dates
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Enumeration Date | 11/09/2023
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 105828 S PARKWOOD MEADOWS DR
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City | MCLOUD
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State | OK
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Zip | 74851-9683
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Country | US
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Telephone | 405-305-7210
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Fax |
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Provider Business Mailing Address
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Address Line | 13501 SE 29TH ST TRLR 121
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City | CHOCTAW
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State | OK
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Zip | 73020-6652
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Country | US
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Telephone | 405-305-7210
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 12041
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License Number State | OK
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