Individual
MRS. KIM LEIGH BIRDSONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1500 N 6TH ST, PONCA CITY, OK 74601-2827
(580) 762-7561
(580) 762-2576
Mailing address
2117 BAINBRIDGE AVE, PONCA CITY, OK 74604-2404
(580) 762-4374
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
3112
OK
Other
Enumeration date
12/04/2006
Last updated
07/08/2007
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