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General NPI Number Information
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NPI Number | 1972897106
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Entity Type | Individual
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Provider Name | KRYSTLE ELAINE COUNTZ B.A., CM II
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Gender | Female
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Dates
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Enumeration Date | 06/06/2011
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Last Update Date | 08/25/2021
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Provider Practice Location Address
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Address Line | 106 S 3RD ST
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City | MCALESTER
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State | OK
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Zip | 74501-5300
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Country | US
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Telephone | 918-421-8880
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Fax |
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Provider Business Mailing Address
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Address Line | 91 W HALL RD
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City | STUART
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State | OK
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Zip | 74570-5192
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Country | US
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Telephone |
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 310780
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License Number State | OK
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