Provider Demographics
NPI:1750595864
Name:WHISENHUNT, KELIS AYN (MA, LPC, CADC)
Entity type:Individual
Prefix:MS
First Name:KELIS
Middle Name:AYN
Last Name:WHISENHUNT
Suffix:
Gender:F
Credentials:MA, LPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:MAUD
Mailing Address - State:OK
Mailing Address - Zip Code:74854-0008
Mailing Address - Country:US
Mailing Address - Phone:405-374-1225
Mailing Address - Fax:866-201-3530
Practice Address - Street 1:32108 HWY 59
Practice Address - Street 2:
Practice Address - City:MAUD
Practice Address - State:OK
Practice Address - Zip Code:74854
Practice Address - Country:US
Practice Address - Phone:405-374-1225
Practice Address - Fax:866-202-3530
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK362101YA0400X
OK6952101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)