Provider Demographics
NPI:1548570179
Name:ALEX, KRISTIN RAE (MED)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:RAE
Last Name:ALEX
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5116 N PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2077
Mailing Address - Country:US
Mailing Address - Phone:405-943-7500
Mailing Address - Fax:
Practice Address - Street 1:5116 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2077
Practice Address - Country:US
Practice Address - Phone:405-943-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-17
Last Update Date:2010-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional