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NPI Code Detail

MEDICARE: CHRISTINE CUSTRED LPC

MEDICARE: CHRISTINE CUSTRED LPC
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
1101YM0800XMental Health Counselor11988OK

General Provider Information

NPI Number : 1760321608
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINE CUSTRED LPC
Provider Business Mailing Address
First Line : 9815 FOREST GLADE DR
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73151-9127
Country : US
Telephone Number : 405-397-9254
Fax Number :
Provider Business Practice Location Address
First Line : 1300 E 15TH ST STE 130
Second Line :
City : EDMOND
State : OK
Zip : 73013-5051
Country : US
Telephone Number : 405-562-3535
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2026
Last Update Date : 03/26/2026

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Directions to “ CHRISTINE CUSTRED LPC” Practice Location

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