Provider Demographics
NPI:1043710353
Name:MERRY, KENSLEY (MA, LPC-S)
Entity type:Individual
Prefix:
First Name:KENSLEY
Middle Name:
Last Name:MERRY
Suffix:
Gender:F
Credentials:MA, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E 15TH ST STE 130
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5051
Mailing Address - Country:US
Mailing Address - Phone:405-726-1555
Mailing Address - Fax:
Practice Address - Street 1:1300 E 15TH ST STE 130
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5051
Practice Address - Country:US
Practice Address - Phone:405-562-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2023-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health