Provider Demographics
NPI:1023361409
Name:MORRELL, KRISTY ANN (LCSW-P)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:ANN
Last Name:MORRELL
Suffix:
Gender:F
Credentials:LCSW-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 MADELINE DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-6564
Mailing Address - Country:US
Mailing Address - Phone:405-585-9653
Mailing Address - Fax:
Practice Address - Street 1:706 MADELINE DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-6564
Practice Address - Country:US
Practice Address - Phone:405-585-9653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4331-P101YP2500X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional