Provider Demographics
NPI:1457619637
Name:NOLAN, KENNETH R (BHRS)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:R
Last Name:NOLAN
Suffix:
Gender:M
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 NW 23RD STREET
Mailing Address - Street 2:100
Mailing Address - City:OKLAHOMA
Mailing Address - State:OK
Mailing Address - Zip Code:73107
Mailing Address - Country:US
Mailing Address - Phone:405-917-1709
Mailing Address - Fax:405-917-1713
Practice Address - Street 1:4209 NW 23RD STREET
Practice Address - Street 2:100
Practice Address - City:OKLAHOMA
Practice Address - State:OK
Practice Address - Zip Code:73107
Practice Address - Country:US
Practice Address - Phone:405-917-1709
Practice Address - Fax:405-917-1713
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health