1518153626 NPI number — ASSOCIATION OF CHRISTIAN THERAPISTS, INC.

Table of content: ALEXANDRA WILSON KENNIE DPT (NPI 1669205829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518153626 NPI number — ASSOCIATION OF CHRISTIAN THERAPISTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATION OF CHRISTIAN THERAPISTS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518153626
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 N BROADWAY
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
ADA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-310-9588
Provider Business Mailing Address Fax Number:
580-310-9586

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 N BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
ADA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-310-9588
Provider Business Practice Location Address Fax Number:
580-310-9586
Provider Enumeration Date:
09/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DUNCAN
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
N.
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
580-310-9588

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  376 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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