Provider Demographics
NPI:1851938278
Name:KIRKES, AMARA LEIGH
Entity Type:Individual
Prefix:
First Name:AMARA
Middle Name:LEIGH
Last Name:KIRKES
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 1:13792 SE 1000TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUSKAHOMA
Mailing Address - State:OK
Mailing Address - Zip Code:74574
Mailing Address - Country:US
Mailing Address - Phone:918-448-5301
Mailing Address - Fax:
Practice Address - Street 1:103 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WILBURTON
Practice Address - State:OK
Practice Address - Zip Code:74578-4043
Practice Address - Country:US
Practice Address - Phone:918-465-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty