Healthcare Provider Details

I. General information

NPI: 1518227008
Provider Name (Legal Business Name): KRYSTAL N VASQUEZ MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRYSTAL N EASTER MS, LPC

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S MUSKOGEE AVE
TAHLEQUAH OK
74464-3834
US

IV. Provider business mailing address

2201 OAKRIDGE DR
TAHLEQUAH OK
74464-8827
US

V. Phone/Fax

Practice location:
  • Phone: 918-216-9665
  • Fax: 918-400-9685
Mailing address:
  • Phone: 918-216-9665
  • Fax: 918-400-9685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC06089
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: