Provider Demographics
NPI:1376617258
Name:KUNKEL, MARIA SUSAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:SUSAN
Last Name:KUNKEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1163
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1163
Mailing Address - Country:US
Mailing Address - Phone:405-713-5792
Mailing Address - Fax:405-713-5786
Practice Address - Street 1:2129 SW 59TH STREET
Practice Address - Street 2:MYHRO CENTER
Practice Address - City:OKC
Practice Address - State:OK
Practice Address - Zip Code:73119-7024
Practice Address - Country:US
Practice Address - Phone:405-713-5792
Practice Address - Fax:405-713-5786
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical