Most Relevant Information
Provider Data
| NPI Number: | 1003174517 |
| Provider Name: | KIMBERLY R COUCH |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/03/2012 |
| Last Updated: | 05/03/2012 |
Provider Practice Location
903 W MAIN ST
ANTLERS
OK
745232045
Practice Location Phone/Fax
| Phone: | 5802983001 |
| Fax: |
Provider Mailing Location
PO BOX 226
RATTAN
OK
745620226
Provider Mailing Phone/Fax
| Phone: | 5802983001 |
| Fax: |