Provider Demographics
NPI:1477733251
Name:MADDOX, KRISTY DEVAN (BA)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:DEVAN
Last Name:MADDOX
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:DEVAN
Other - Last Name:BRIGANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:802 E MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-2771
Mailing Address - Country:US
Mailing Address - Phone:918-967-4463
Mailing Address - Fax:918-967-2594
Practice Address - Street 1:802 E MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-2771
Practice Address - Country:US
Practice Address - Phone:918-967-4463
Practice Address - Fax:918-967-2594
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)