Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 5067 | OK |
NPI | 1003063413 |
---|---|
Provider Name | Kacy Leigh Duvall |
First Address | Tulsa, OK 74119-4003 |
Second Address | Tulsa, OK 74119-4003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2008 |
Last Update Date | 13/02/2017 |