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NPI Code Detail

MEDICARE: MR. STEPHEN LEE KRISTIC LCSW

MEDICARE: MR. STEPHEN LEE KRISTIC LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician1226OK

General Provider Information

NPI Number : 1457460495
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. STEPHEN LEE KRISTIC LCSW
Provider Business Mailing Address
First Line : 1117 NW 50TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73118-4401
Country : US
Telephone Number : 405-842-4435
Fax Number : 405-842-2846
Provider Business Practice Location Address
First Line : 1117 NW 50TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73118-4401
Country : US
Telephone Number : 405-842-4435
Fax Number : 405-842-2846
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 07/08/2007

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