Healthcare Provider Details

I. General information

NPI: 1538376702
Provider Name (Legal Business Name): KRISS SUZANNE THOMSON CADC, BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 SW 15TH ST
OKLAHOMA CITY OK
73108-6803
US

IV. Provider business mailing address

2126 NW 22ND ST
OKLAHOMA CITY OK
73107-3518
US

V. Phone/Fax

Practice location:
  • Phone: 405-634-0508
  • Fax: 405-616-5678
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number264
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: