MEDICARE: MRS. KRISTEN KOTSENBURG

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	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780238527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTEN KOTSENBURG

Provider Business Mailing Address
First Line	:	9613 LYRIC LN
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-6407
Country	:	US
Telephone Number	:	307-640-6967
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 PARKLAWN DR STE 201
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-4229
Country	:	US
Telephone Number	:	405-733-5437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2019
Last Update Date	:	09/16/2022

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