Provider Demographics
NPI:1295036465
Name:FREELEN, KENYA R (BA)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:R
Last Name:FREELEN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 N CLASSEN BLVD
Mailing Address - Street 2:240
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-2872
Mailing Address - Country:US
Mailing Address - Phone:405-606-8406
Mailing Address - Fax:405-606-8194
Practice Address - Street 1:3700 N CLASSEN BLVD
Practice Address - Street 2:240
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-2872
Practice Address - Country:US
Practice Address - Phone:405-606-8406
Practice Address - Fax:405-606-8194
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200079250AMedicaid