Basic Information
| Provider Information | |||||||||
| NPI: | 1528468154 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KFG COUNSELING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4012 SAM GORDON DR | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730724023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149388812 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3280 MARSHALL AVE | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730728022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149388812 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2014 | ||||||||
| LastUpdateDate: | 09/02/2014 | ||||||||
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| AuthorizedOfficialLastName: | GAYLOR | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 2149388812 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 4360 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.