Provider Demographics
NPI:1417330382
Name:TRUNDLE, KRISTA (BHCMII)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:TRUNDLE
Suffix:
Gender:F
Credentials:BHCMII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 W CADDO ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OK
Mailing Address - Zip Code:74020-4201
Mailing Address - Country:US
Mailing Address - Phone:918-308-5511
Mailing Address - Fax:
Practice Address - Street 1:907 W CADDO ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OK
Practice Address - Zip Code:74020-4201
Practice Address - Country:US
Practice Address - Phone:918-308-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor