Provider Demographics
NPI:1578833042
Name:CRONISTER, DELBERT ELMER (BHRS)
Entity Type:Individual
Prefix:MR
First Name:DELBERT
Middle Name:ELMER
Last Name:CRONISTER
Suffix:
Gender:M
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 N. FIR ST
Mailing Address - Street 2:
Mailing Address - City:CRESCENT
Mailing Address - State:OK
Mailing Address - Zip Code:73028-9078
Mailing Address - Country:US
Mailing Address - Phone:405-609-9036
Mailing Address - Fax:
Practice Address - Street 1:324 N FIR ST
Practice Address - Street 2:
Practice Address - City:CRESCENT
Practice Address - State:OK
Practice Address - Zip Code:73028-9078
Practice Address - Country:US
Practice Address - Phone:405-609-9036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKBHRS101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor