Provider Demographics
NPI:1053641357
Name:BARTH, KRISTA SUSANNE (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:SUSANNE
Last Name:BARTH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4350
Mailing Address - Country:US
Mailing Address - Phone:405-624-5840
Mailing Address - Fax:405-533-2888
Practice Address - Street 1:807 S PINE ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4350
Practice Address - Country:US
Practice Address - Phone:405-624-5840
Practice Address - Fax:405-533-2888
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2629101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional