Provider Demographics
NPI:1992024145
Name:CUNNINGHAM, KASEY (BS)
Entity Type:Individual
Prefix:MRS
First Name:KASEY
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 W WILSHIRE BLVD STE 114
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7738
Mailing Address - Country:US
Mailing Address - Phone:405-334-2624
Mailing Address - Fax:
Practice Address - Street 1:730 W WILSHIRE BLVD STE 114
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7738
Practice Address - Country:US
Practice Address - Phone:405-334-2624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13425103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200353710AMedicaid