Basic Information
| Provider Information | |||||||||
| NPI: | 1508531336 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LITTLEDEER | ||||||||
| FirstName: | KINSEY | ||||||||
| MiddleName: | BROOKE | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 FOREST GLENN CIR | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730715100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056234037 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 624 NW 5TH ST | ||||||||
| Address2: | |||||||||
| City: | MOORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731603924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057993379 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2021 | ||||||||
| LastUpdateDate: | 08/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.