Provider Demographics
NPI:1518581008
Name:KOONCE, CAMERON KRISTINE (MFT CANDIDATE)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:KRISTINE
Last Name:KOONCE
Suffix:
Gender:F
Credentials:MFT CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13929 TECHNOLOGY DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1053
Mailing Address - Country:US
Mailing Address - Phone:405-434-2909
Mailing Address - Fax:
Practice Address - Street 1:13929 TECHNOLOGY DR UNIT A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1053
Practice Address - Country:US
Practice Address - Phone:405-434-2909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
OK390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist