Individual
MR. MICHAEL KEITH KENNISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
616 S BOSTON AVE STE 400, TULSA, OK 74119-1216
(918) 382-7300
Mailing address
616 S BOSTON AVE STE 400, TULSA, OK 74119-1216
(918) 382-7300
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
3401
OK
104100000X
Social Worker
6697
KS
Other
Enumeration date
07/10/2007
Last updated
07/10/2007
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