Provider Demographics
NPI:1043503121
Name:KAY, JUSTIN WADE
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:WADE
Last Name:KAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 ANN BRANDEN BLVD
Mailing Address - Street 2:APT #926
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-1561
Mailing Address - Country:US
Mailing Address - Phone:580-421-6791
Mailing Address - Fax:405-573-3966
Practice Address - Street 1:103 GIBBS ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071
Practice Address - Country:US
Practice Address - Phone:405-573-3995
Practice Address - Fax:405-573-3966
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health