Healthcare Provider Details

I. General information

NPI: 1306459193
Provider Name (Legal Business Name): KRISTEN ANDERSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 24TH AVE NW
NORMAN OK
73069-6369
US

IV. Provider business mailing address

3016 SHIRLEY LN
OKLAHOMA CITY OK
73116-3122
US

V. Phone/Fax

Practice location:
  • Phone: 405-310-3262
  • Fax: 405-876-6364
Mailing address:
  • Phone: 405-568-1440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10815
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: