Healthcare Provider Details

I. General information

NPI: 1003727009
Provider Name (Legal Business Name): HILLSIDE INTEGRATED THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W 1ST ST
CHANDLER OK
74834-2004
US

IV. Provider business mailing address

345354 E 960 RD
CHANDLER OK
74834-9258
US

V. Phone/Fax

Practice location:
  • Phone: 405-588-8854
  • Fax:
Mailing address:
  • Phone: 405-588-8854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: CHRISTY MARTIN
Title or Position: OWNER/OPERATOR
Credential: LPC
Phone: 602-316-5802