Provider Demographics
NPI:1568158293
Name:WOOD, KRISTINA (LADC-MH SUPERVISION)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:LADC-MH SUPERVISION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TISHOMINGO
Mailing Address - State:OK
Mailing Address - Zip Code:73460-2002
Mailing Address - Country:US
Mailing Address - Phone:580-257-9614
Mailing Address - Fax:
Practice Address - Street 1:102 E 4TH ST
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460-2002
Practice Address - Country:US
Practice Address - Phone:580-257-9614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor