Healthcare Provider Details

I. General information

NPI: 1770531006
Provider Name (Legal Business Name): KRIS RENE NEWLIN MAT, LPC, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6656 NW 39TH EXPY STE 105
BETHANY OK
73008-2704
US

IV. Provider business mailing address

6656 NW 39TH EXPY STE 105
BETHANY OK
73008-2704
US

V. Phone/Fax

Practice location:
  • Phone: 405-535-9413
  • Fax:
Mailing address:
  • Phone: 405-535-9413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2282
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: