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General NPI Number Information
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NPI Number | 1942539135
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Entity Type | Individual
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Provider Name | KENNETH D. CONTREREAS LPC
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Gender | Male
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Dates
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Enumeration Date | 12/16/2009
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Last Update Date | 08/26/2010
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Provider Practice Location Address
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Address Line | 6218 S LEWIS AVE SUITE 115
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City | TULSA
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State | OK
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Zip | 74136-1018
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Country | US
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Telephone | 918-231-3995
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Fax | 918-747-0164
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Provider Business Mailing Address
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Address Line | 10349 S 156TH WEST AVE
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City | SAPULPA
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State | OK
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Zip | 74066-9208
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Country | US
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Telephone | 918-231-3995
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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 | 1247
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License Number State | OK
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