Provider Demographics
NPI:1295018638
Name:BOLLEY, CRISTINE BRENDA (MA LPC NCC)
Entity Type:Individual
Prefix:MRS
First Name:CRISTINE
Middle Name:BRENDA
Last Name:BOLLEY
Suffix:
Gender:F
Credentials:MA LPC NCC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:712 N SWEET GUM AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-2156
Mailing Address - Country:US
Mailing Address - Phone:918-850-2747
Mailing Address - Fax:888-446-1174
Practice Address - Street 1:1175 S ASPEN AVE
Practice Address - Street 2:STE J
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-4800
Practice Address - Country:US
Practice Address - Phone:918-850-2747
Practice Address - Fax:888-446-1174
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor