Provider Demographics
NPI:1285063750
Name:DUEL, KIMBERLY L
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:DUEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 580700
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74158
Mailing Address - Country:US
Mailing Address - Phone:918-430-0975
Mailing Address - Fax:918-430-0995
Practice Address - Street 1:2442 MOHAWK BLVD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74110
Practice Address - Country:US
Practice Address - Phone:918-430-0975
Practice Address - Fax:918-430-0995
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OK6024101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor