Healthcare Provider Details

I. General information

NPI: 1972804847
Provider Name (Legal Business Name): STEPHANIE LATRESE CHRISTIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 W BROADWAY ST
ARDMORE OK
73401-4526
US

IV. Provider business mailing address

1612 CARPENTER DR
PLANO TX
75074-8645
US

V. Phone/Fax

Practice location:
  • Phone: 580-224-2830
  • Fax: 580-223-7856
Mailing address:
  • Phone: 405-653-5895
  • Fax: 580-223-7856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number98769
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11460
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: