Provider Demographics
NPI:1700136413
Name:LASSLEY, KENDRA LEA (BE)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:LEA
Last Name:LASSLEY
Suffix:
Gender:F
Credentials:BE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 EAST CRAZY HORSE AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-5417
Mailing Address - Country:US
Mailing Address - Phone:918-225-9428
Mailing Address - Fax:
Practice Address - Street 1:9210 SOUTH WESTERN AVE
Practice Address - Street 2:A 21
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-8605
Practice Address - Country:US
Practice Address - Phone:405-626-1711
Practice Address - Fax:405-892-7544
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No174400000XOther Service ProvidersSpecialist