Provider Demographics
NPI:1942539135
Name:CONTREREAS, KENNETH D (LPC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:D
Last Name:CONTREREAS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10349 S 156TH WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-9208
Mailing Address - Country:US
Mailing Address - Phone:918-231-3995
Mailing Address - Fax:
Practice Address - Street 1:6218 S LEWIS AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1018
Practice Address - Country:US
Practice Address - Phone:918-231-3995
Practice Address - Fax:918-747-0164
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1247101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional