Individual
KIMBERLY BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
112 W MAIN ST, PURCELL, OK 73080-4220
(405) 527-1785
(405) 527-1084
Mailing address
PO BOX 662, PURCELL, OK 73080-0662
(405) 527-1785
(405) 527-1084
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
07469
OK
Other
Enumeration date
08/12/2015
Last updated
03/09/2023
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