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General NPI Number Information
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NPI Number | 1194296210
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Entity Type | Individual
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Provider Name | DESMOND E KETTER LPC
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Gender | Male
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 5840 S MEMORIAL DR STE 330
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City | TULSA
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State | OK
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Zip | 74145-9060
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Country | US
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Telephone | 918-200-9830
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Fax | 918-601-8103
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Provider Business Mailing Address
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Address Line | 3108 S HEMLOCK CT
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City | BROKEN ARROW
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State | OK
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Zip | 74012-7602
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Country | US
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Telephone | 918-645-6064
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 10952
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License Number State | OK
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