Provider Demographics
NPI:1326329236
Name:CHRISTIAN, TELISHA KALE (PSRS)
Entity Type:Individual
Prefix:MS
First Name:TELISHA
Middle Name:KALE
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:PSRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 N KAISER RD
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-2224
Mailing Address - Country:US
Mailing Address - Phone:580-774-1231
Mailing Address - Fax:
Practice Address - Street 1:1221 N KAISER RD
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-2224
Practice Address - Country:US
Practice Address - Phone:580-774-1231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKP081919379104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker