Individual
KIRK HODARI RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BHRS
Contact information
Practice address
32 N WASHINGTON ST, ARDMORE, OK 73401-7013
(580) 226-5209
(580) 226-5219
Mailing address
527 2ND AVE SE, ARDMORE, OK 73401-8075
(580) 465-9293
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200049040
—
OK
Enumeration date
09/12/2011
Last updated
09/12/2011
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