Provider Demographics
NPI:1508642570
Name:HUNTER, KEATON LAINE (LMSW)
Entity Type:Individual
Prefix:
First Name:KEATON
Middle Name:LAINE
Last Name:HUNTER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4317 SW 22ND ST APT 111
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108-1907
Mailing Address - Country:US
Mailing Address - Phone:281-384-1785
Mailing Address - Fax:
Practice Address - Street 1:1400 SE 4TH ST STE A
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-7328
Practice Address - Country:US
Practice Address - Phone:405-837-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker