MEDICARE: CHRISTINA CONRAD, LPC, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1497368245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTINA CONRAD, LPC, PLLC

Provider Business Mailing Address
First Line	:	5327 S SHERIDAN RD
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74145-7521
Country	:	US
Telephone Number	:	918-694-6606
Fax Number	:

Provider Business Practice Location Address
First Line	:	5327 S SHERIDAN RD
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74145-7521
Country	:	US
Telephone Number	:	918-694-6606
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE AND CLINICAL DIRECTOR
Name	:	CHRSITINA MARIE CONRAD
Credential	:	LPC, SEP
Telephone Number	:	918-694-6606

Provider Enumeration Date	:	08/30/2020
Last Update Date	:	08/30/2020

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