Provider Demographics
NPI:1508071887
Name:STREET, KRISTEN (MED, LPC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:STREET
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7913 HIGHWAY 270 BLDG A
Mailing Address - Street 2:
Mailing Address - City:HOLDENVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74848-6416
Mailing Address - Country:US
Mailing Address - Phone:405-360-2133
Mailing Address - Fax:405-360-2252
Practice Address - Street 1:2010 BOREN BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868-2050
Practice Address - Country:US
Practice Address - Phone:405-382-4507
Practice Address - Fax:405-382-5269
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2892101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health