Provider Demographics
NPI:1720282783
Name:DUVALL, KASSIE
Entity Type:Individual
Prefix:
First Name:KASSIE
Middle Name:
Last Name:DUVALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 S HARVARD AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-3305
Mailing Address - Country:US
Mailing Address - Phone:918-732-7560
Mailing Address - Fax:918-587-0419
Practice Address - Street 1:2325 S HARVARD AVE STE 500
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-3305
Practice Address - Country:US
Practice Address - Phone:918-732-7560
Practice Address - Fax:918-587-0419
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health