MEDICARE: KRIS RENE NEWLIN MAT, LPC, ATR-BC

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
1	101YP2500X	Professional Counselor	2282	OK

General Provider Information

NPI Number	:	1770531006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRIS RENE NEWLIN MAT, LPC, ATR-BC

Provider Business Mailing Address
First Line	:	6656 NW 39TH EXPY STE 105
Second Line	:
City	:	BETHANY
State	:	OK
Zip	:	73008-2704
Country	:	US
Telephone Number	:	405-535-9413
Fax Number	:

Provider Business Practice Location Address
First Line	:	6656 NW 39TH EXPY STE 105
Second Line	:
City	:	BETHANY
State	:	OK
Zip	:	73008-2704
Country	:	US
Telephone Number	:	405-535-9413
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	05/05/2026

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