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General NPI Number Information
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NPI Number | 1053851543
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Entity Type | Organization
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Legal Business Name | KRISTA M DOLL LLC
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Dates
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Enumeration Date | 03/02/2017
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Last Update Date | 03/02/2017
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Provider Practice Location Address
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Address Line | 4816 SW 129TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73173-8917
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Country | US
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Telephone | 405-641-1084
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Fax |
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Provider Business Mailing Address
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Address Line | 4816 SW 129TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73173-8917
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Country | US
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Telephone | 405-641-1084
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRISTA DOLL
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Credential | M.ED., LPC
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Telephone | 405-641-1084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6192
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6192
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6192
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License Number State | OK
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