Doctor Name: | CRISTY ROBERTS |
NPI Number: | 1306171848 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 512 E 24th St Tishomingo, OK - 734603214 |
Business Phone Number: | 5803713672 |
Business Fax Number: | 5803713651 |
Mailing Address: | 512 East 24th Street, TISHOMINGO |
State: | OK |
Postal Code: | 73460 |
Phone Number: | 5803713672 |
Fax Number: | 5803713651 |
NPI Enumeration Date: | 10/15/2009 |
NPI Last Update Date: | 10/15/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |