Healthcare Provider Details

I. General information

NPI: 1568758944
Provider Name (Legal Business Name): CHRISTINA CONRAD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2442 MOHAWK BLVD
TULSA OK
74110
US

IV. Provider business mailing address

P.O. BOX 580700
TULSA OK
74158
US

V. Phone/Fax

Practice location:
  • Phone: 918-342-0770
  • Fax: 918-342-0087
Mailing address:
  • Phone: 918-430-0975
  • Fax: 918-430-0995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5073
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5073
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: