Provider Demographics
NPI:1548512825
Name:MOTLEY, KIMBERLY MARIE (BACHELOR OF FINE ART)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MARIE
Last Name:MOTLEY
Suffix:
Gender:F
Credentials:BACHELOR OF FINE ART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10245 HECTORVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNDS
Mailing Address - State:OK
Mailing Address - Zip Code:74047-4249
Mailing Address - Country:US
Mailing Address - Phone:918-994-1249
Mailing Address - Fax:
Practice Address - Street 1:10245 HECTORVILLE RD
Practice Address - Street 2:
Practice Address - City:MOUNDS
Practice Address - State:OK
Practice Address - Zip Code:74047-4249
Practice Address - Country:US
Practice Address - Phone:918-994-1249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor