Provider Demographics
NPI:1255633111
Name:MASENGALE, KIMBERLY A (MA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:MASENGALE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 NW 63RD ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3632
Mailing Address - Country:US
Mailing Address - Phone:405-842-0684
Mailing Address - Fax:
Practice Address - Street 1:3035 NW 63RD ST
Practice Address - Street 2:SUITE 202
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3632
Practice Address - Country:US
Practice Address - Phone:405-842-0684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist