Individual
KENNYON GLENN WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1209 W HEFNER RD, APT 162, OKLAHOMA CITY, OK 73114-7007
(405) 305-9476
Mailing address
1209 W HEFNER RD, APT 162, OKLAHOMA CITY, OK 73114-7007
(405) 305-9476
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
05/07/2013
Last updated
05/07/2013
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