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Individual

KENNETH WAYNE ELLIOTT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LMFT

Contact information

Practice address
1308 COPPERFIELD DR, EDMOND, OK 73003-6101
(405) 715-0216
Mailing address
1308 COPPERFIELD DR, EDMOND, OK 73003-6101
(405) 715-0216

Taxonomy

Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
763
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100742400B
OK
Enumeration date
01/21/2009
Last updated
01/21/2009
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