Provider Demographics
NPI:1184669780
Name:MCKUNE, KRISTINA L (LPC, LADC, NCC, ACHT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:L
Last Name:MCKUNE
Suffix:
Gender:F
Credentials:LPC, LADC, NCC, ACHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:ELDORADO
Mailing Address - State:OK
Mailing Address - Zip Code:73537-0112
Mailing Address - Country:US
Mailing Address - Phone:580-379-4900
Mailing Address - Fax:580-379-4921
Practice Address - Street 1:118 W BROADWAY ST STE 102
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-3816
Practice Address - Country:US
Practice Address - Phone:580-379-4900
Practice Address - Fax:580-379-4921
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2729101YM0800X
OK129101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health