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General NPI Number Information
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NPI Number | 1679843189
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Entity Type | Individual
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Provider Name | CHRISTY TANUSAPUTRA MA, NCC, LPC, LAC
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Gender | Female
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Dates
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Enumeration Date | 01/01/2012
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Last Update Date | 11/26/2023
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Provider Practice Location Address
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Address Line | 5200 S YALE AVE STE 400
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City | TULSA
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State | OK
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Zip | 74135-7489
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Country | US
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Telephone | 918-236-0150
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Fax |
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Provider Business Mailing Address
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Address Line | 4038 E 53RD ST
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City | TULSA
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State | OK
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Zip | 74135-4816
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Country | US
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Telephone | 918-688-0903
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0011344
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License Number State | CO
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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 | 10674
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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 | 12274
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 325
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License Number State | CO
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