Provider Demographics
NPI:1326054891
Name:KISHUR, G. RICHARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:G. RICHARD
Middle Name:
Last Name:KISHUR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 RICHMOND SQ
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-2023
Mailing Address - Country:US
Mailing Address - Phone:405-848-3373
Mailing Address - Fax:405-848-3458
Practice Address - Street 1:4901 RICHMOND SQ
Practice Address - Street 2:SUITE 102
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-2023
Practice Address - Country:US
Practice Address - Phone:405-848-3373
Practice Address - Fax:405-848-3458
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1278101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional