Healthcare Provider Details

I. General information

NPI: 1598671596
Provider Name (Legal Business Name): KRISTEN COLON-MENDIOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 SW C AVE
LAWTON OK
73501-4016
US

IV. Provider business mailing address

210 SE COACHMAN DR
LAWTON OK
73501-6334
US

V. Phone/Fax

Practice location:
  • Phone: 360-451-4227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13593
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: