Healthcare Provider Details

I. General information

NPI: 1225040553
Provider Name (Legal Business Name): CRYSTAL ANNETTE ROARK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 STANTON L YOUNG BLVD STE 3240
OKLAHOMA CITY OK
73104-5036
US

IV. Provider business mailing address

920 STANTON L YOUNG BLVD STE 3240
OKLAHOMA CITY OK
73104-5036
US

V. Phone/Fax

Practice location:
  • Phone: 572-244-0061
  • Fax: 572-244-9829
Mailing address:
  • Phone: 572-244-0061
  • Fax: 572-244-9829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC06280
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: