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NPI Code Detail

MEDICARE: MRS. PENNY KAY MAINS LMFT CANDIDATE

MEDICARE: MRS. PENNY KAY MAINS LMFT CANDIDATE
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1881872125
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PENNY KAY MAINS LMFT CANDIDATE
Provider Business Mailing Address
First Line : 9700 S PENNSYLVANIA AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73159-6917
Country : US
Telephone Number : 405-735-9732
Fax Number :
Provider Business Practice Location Address
First Line : 9700 S PENNSYLVANIA AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73159-6917
Country : US
Telephone Number : 405-735-9732
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2008
Last Update Date : 06/12/2012

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