Provider Demographics
NPI:1366723629
Name:NORRIS, KENNETH WARREN (LPC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:WARREN
Last Name:NORRIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 N RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-1644
Mailing Address - Country:US
Mailing Address - Phone:580-889-9848
Mailing Address - Fax:
Practice Address - Street 1:1697 S GREATHOUSE DR
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-3407
Practice Address - Country:US
Practice Address - Phone:580-889-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OKLPC07565101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor