Provider Demographics
NPI:1003538364
Name:KRISTA HEARON LPC LLC
Entity Type:Organization
Organization Name:KRISTA HEARON LPC LLC
Other - Org Name:KRISTA BATES LPC LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEARON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-938-5786
Mailing Address - Street 1:1515 EDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-4929
Mailing Address - Country:US
Mailing Address - Phone:405-938-5786
Mailing Address - Fax:
Practice Address - Street 1:1515 EDGEWOOD LN
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-4929
Practice Address - Country:US
Practice Address - Phone:405-938-5786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-14
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK07334OtherLPC LICENSE