Healthcare Provider Details

I. General information

NPI: 1154691509
Provider Name (Legal Business Name): CHRISTY MATTESON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 10/06/2024
Certification Date: 10/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355004 E 750 RD
CUSHING OK
74023-5269
US

IV. Provider business mailing address

355004 E 750 RD
CUSHING OK
74023-5269
US

V. Phone/Fax

Practice location:
  • Phone: 918-225-0750
  • Fax:
Mailing address:
  • Phone: 918-225-0750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number07458
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7458
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: