Provider Demographics
NPI:1205377264
Name:RYALS, KRISSTYN ELISSA (LPC, CANDIDATE)
Entity Type:Individual
Prefix:MISS
First Name:KRISSTYN
Middle Name:ELISSA
Last Name:RYALS
Suffix:
Gender:F
Credentials:LPC, CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17576 W LISA DR
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-0326
Mailing Address - Country:US
Mailing Address - Phone:918-772-4018
Mailing Address - Fax:918-207-4911
Practice Address - Street 1:1510 E SHAWNEE CIR
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464
Practice Address - Country:US
Practice Address - Phone:918-772-4018
Practice Address - Fax:918-207-0424
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional