Provider Demographics
NPI:1265259667
Name:TUNNELL, KIMBERLY R (LMSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:TUNNELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 N VILLA AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-6439
Mailing Address - Country:US
Mailing Address - Phone:970-773-1292
Mailing Address - Fax:
Practice Address - Street 1:823 N VILLA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-6439
Practice Address - Country:US
Practice Address - Phone:970-773-1292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21069-P104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker