Individual
MR. MARK DOUGLAS KINNISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.ED, CRC,LPC
Contact information
Practice address
5773 W 1ST ST, TULSA, OK 74127-5723
(918) 241-6705
Mailing address
5773 W 1ST ST, TULSA, OK 74127-5723
(918) 241-6705
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3008
OK
Other
Enumeration date
01/09/2009
Last updated
01/09/2009
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