Provider Demographics
NPI:1194080432
Name:KLUNGNES, MARY ANNE (MS, BHRS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANNE
Last Name:KLUNGNES
Suffix:
Gender:F
Credentials:MS, BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 N COUNCIL RD APT 6
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-4366
Mailing Address - Country:US
Mailing Address - Phone:405-470-7995
Mailing Address - Fax:
Practice Address - Street 1:10700 N COUNCIL RD APT 6
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-4366
Practice Address - Country:US
Practice Address - Phone:405-470-7995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health