Provider Demographics
NPI:1578864385
Name:MAXWELL, KRISTI (MS LPC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-3436
Mailing Address - Country:US
Mailing Address - Phone:405-761-0313
Mailing Address - Fax:
Practice Address - Street 1:308 S COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-5009
Practice Address - Country:US
Practice Address - Phone:405-761-0313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional