TERESA WILIE KENNISON (NPI# 1083919179) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083919179 |
| Entity Type | Individual |
| Full Name | TERESA WILIE KENNISON |
| Credential | MS, LPC-CANDIDATE |
| Practice Address |
1350 S Muldrow St Tishomingo OK 73460-3278 |
| Practice Telephone | 5805793620 |
| Mailing Telephone | 5805793620 |
| Enumeration Date | 2011-01-20 |
| Last Update Date | 2013-04-01 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| N | 103K00000X | Behavioral Analyst | Behavioral Health & Social Service Providers |
| Street Address |
1350 S MULDROW ST |
| City | TISHOMINGO |
| State | OK |
| Zip Code | 73460-3278 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841636115 | Ethan Wade Taylor | Case Manager/Care Coordinator | 1350 S Muldrow St, Tishomingo, OK 73460-3278 | 2013-05-14 |
| 1194068049 | Kevin Edmondson | Case Manager/Care Coordinator | 1350 S Muldrow St, Tishomingo, OK 73460-3278 | 2013-03-28 |
| 1609137215 | Hailey Celeste Bailey | Behavioral Analyst | 1350 S Muldrow St, Tishomingo, OK 73460-3278 | 2012-05-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912380742 | Lori Pigg | Speech-Language Pathologist | 508 N. Neshoba, Tishomingo, OK 73460 | 2015-06-29 |
| 1407241748 | Brittany Walker | Case Management | 850 E. Highway 22, Tishomingo, OK 73460 | 2015-04-03 |
| 1427460641 | Elizabeth Mcdonald | Counselor | 512 East 24th, Tishomingo, OK 73460 | 2014-05-22 |
| 1619387131 | Sheri Slaughter | Counselor | 102 N. Neshoba, Tishomingo, OK 73460 | 2014-05-06 |
| 1336559848 | Heather Marlatt | Counselor | 102 North Neshoba, Tishomingo, OK 73460 | 2014-05-06 |
| 1811231939 | Wanda Luann Beesley Gray | Emergency Medical Technician, Paramedic | 3100 E St Hwy 78, Tishomingo, OK 73460 | 2012-11-15 |
| 1497014724 | Jessica Kay Johnston | Counselor | Outpatient Services-tishomingo; 817 E. 6th St., Strong Family Development, Tishomingo, OK 73460 | 2012-05-07 |
| 1487910949 | Rhonda Gayle Harrison | Counselor | 817 E. 6th St., Medical Family Therapy, Tishomingo, OK 73460 | 2012-04-09 |
| 1265704183 | Parks Family Dental | Preferred Provider Organization | 1520 E. Main Street, Tishomingo, OK 73460 | 2012-02-08 |
| 1770852295 | Gina Marice Frazier | Social Worker | Outpatient Services- Tishomingo, 817 E. 6th St., Tishomingo, OK 73460 | 2011-12-29 |
| Find all providers in zip 73460 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427460641 | Elizabeth Mcdonald | Counselor | 512 East 24th, Tishomingo, OK 73460 | 2014-05-22 |
| 1720417652 | Candice Oliver | Counselor | 202 South Broadway B2, Tishomingo, OK 73406 | 2013-11-01 |
| 1386083988 | Danielle Ophellia Brown | Counselor | 605 E 8th, Tishomingo, OK 73460-2351 | 2013-06-18 |
| 1124462825 | Ronald Ray Hart | Counselor | 1303 E Cheadle Rd, Tishomingo, OK 73460-4205 | 2013-04-24 |
| 1508115791 | Steve Devol Cheadle | Counselor | 304 S Muldrow St, Tishomingo, OK 73460-2733 | 2012-09-03 |
| 1497014724 | Jessica Kay Johnston | Counselor | Outpatient Services-tishomingo; 817 E. 6th St., Strong Family Development, Tishomingo, OK 73460 | 2012-05-07 |
| 1487910949 | Rhonda Gayle Harrison | Counselor | 817 E. 6th St., Medical Family Therapy, Tishomingo, OK 73460 | 2012-04-09 |
| 1952628612 | Shanna Hobbs | Counselor | 608 East 24th, Tishomingo, OK 73460 | 2010-04-21 |
| 1417273483 | Lacy Anne Borengasser | Counselor | 705 W Main, Pennington Creek Lifehouse, Tishomingo, OK 73460 | 2010-04-15 |
| 1396972204 | Carey Smith | Counselor | 200 E. Wilson, Tishomingo, OK 73460 | 2009-06-18 |
| Find all providers in TISHOMINGO | ||||
| City | TISHOMINGO |
| Zip Code | 73460 |
Please comment or provide details below to improve the information on TERESA WILIE KENNISON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.