Provider Demographics
NPI:1194296210
Name:KETTER, DESMOND E (LPC)
Entity type:Individual
Prefix:MR
First Name:DESMOND
Middle Name:E
Last Name:KETTER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:DESMOND
Other - Middle Name:E
Other - Last Name:KETTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3108 S HEMLOCK CT
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7602
Mailing Address - Country:US
Mailing Address - Phone:918-645-6064
Mailing Address - Fax:
Practice Address - Street 1:23 E ROSS AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-6423
Practice Address - Country:US
Practice Address - Phone:918-645-6064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10952101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional