Provider Demographics
NPI:1477824100
Name:DANIEL, KRISTIE LYNN (MBS)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:LYNN
Last Name:DANIEL
Suffix:
Gender:F
Credentials:MBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 E WINDY LN
Mailing Address - Street 2:
Mailing Address - City:LANE
Mailing Address - State:OK
Mailing Address - Zip Code:74555-1700
Mailing Address - Country:US
Mailing Address - Phone:918-698-0729
Mailing Address - Fax:
Practice Address - Street 1:1049 E WINDY LN
Practice Address - Street 2:
Practice Address - City:LANE
Practice Address - State:OK
Practice Address - Zip Code:74555-1700
Practice Address - Country:US
Practice Address - Phone:918-698-0729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health