Active NPI
Mark Douglas Kinnison, M.ED, CRC,LPC
- Professional Counselor
- Tulsa, OK
National Provider Identifier
1134366396
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 3008
- Practice address
- 5773 W 1St St
Tulsa, OK 74127-5723 - Phone
- (918) 241-6705
- NPI assigned
- Jan 9, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 3008 | OK | Primary |
Addresses
Primary practice location
5773 W 1St St
Tulsa, OK 74127-5723
Mailing address
5773 W 1St St
Tulsa, OK 74127-5723
Phone (918) 241-6705
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3008 | OK | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231459200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231459200000",
"number": "1134366396",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5773 W 1ST ST",
"city": "TULSA",
"state": "OK",
"postal_code": "741275723",
"telephone_number": "918-241-6705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5773 W 1ST ST",
"city": "TULSA",
"state": "OK",
"postal_code": "741275723",
"telephone_number": "918-241-6705"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KINNISON",
"first_name": "MARK",
"middle_name": "DOUGLAS",
"name_prefix": "Mr.",
"credential": "M.ED, CRC,LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-01-09",
"last_updated": "2009-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OK",
"license": "3008",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tulsa, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.