MEDICARE: KIDVENTURES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1649754946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDVENTURES, LLC

Provider Business Mailing Address
First Line	:	2405 SW 100TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7503
Country	:	US
Telephone Number	:	405-205-8999
Fax Number	:

Provider Business Practice Location Address
First Line	:	6401 BENT WOOD DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73169-6224
Country	:	US
Telephone Number	:	405-205-8999
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MRS. BILLIE GEAN THOMPSON
Credential	:	MS, LPC-S, RPT-S
Telephone Number	:	405-205-8999

Provider Enumeration Date	:	09/21/2018
Last Update Date	:	07/23/2024

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