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General NPI Number Information
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NPI Number | 1598143984
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Entity Type | Individual
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Provider Name | KRISTIN AVANCE LMSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/18/2015
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Last Update Date | 08/06/2019
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Provider Practice Location Address
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Address Line | 1277 SKILL CENTER CIR
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City | TAHLEQUAH
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State | OK
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Zip | 74464-6495
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Country | US
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Telephone | 918-772-4004
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Fax | 918-431-1173
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Provider Business Mailing Address
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Address Line | 1510 E SHAWNEE CIR
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City | TAHLEQUAH
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State | OK
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Zip | 74464-2528
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Country | US
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Telephone | 918-772-4004
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Fax | 918-207-0424
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6233
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License Number State | OK
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