Healthcare Provider Details

I. General information

NPI: 1790091171
Provider Name (Legal Business Name): KRISTEN HURLBERT MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN JOHNSON MSW

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 N EIGHT TRIBES TRL STE B
MIAMI OK
74354-1010
US

IV. Provider business mailing address

21 N EIGHT TRIBES TRL STE B
MIAMI OK
74354-1010
US

V. Phone/Fax

Practice location:
  • Phone: 918-418-0201
  • Fax:
Mailing address:
  • Phone: 918-418-0201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number05942
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2010028026
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4161
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: