Provider Demographics
NPI:1629706072
Name:ADETOLA, KENESHA RASAHE
Entity Type:Individual
Prefix:
First Name:KENESHA
Middle Name:RASAHE
Last Name:ADETOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 RICHMOND SQ STE 110
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-2040
Mailing Address - Country:US
Mailing Address - Phone:580-649-4425
Mailing Address - Fax:
Practice Address - Street 1:313 SW CORAL AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9577
Practice Address - Country:US
Practice Address - Phone:580-458-8701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst