Provider Demographics
NPI:1083855845
Name:CRIDER, KIRSTEN INGEBORG (LCSW)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:INGEBORG
Last Name:CRIDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 MCNAMEE ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-5448
Mailing Address - Country:US
Mailing Address - Phone:405-402-9653
Mailing Address - Fax:
Practice Address - Street 1:700 S TELEPHONE RD STE 302
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2550
Practice Address - Country:US
Practice Address - Phone:405-912-3995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK35381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical