Provider Demographics
NPI:1679843189
Name:TANUSAPUTRA, CHRISTY (MA, NCC, LPC, LAC)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:TANUSAPUTRA
Suffix:
Gender:F
Credentials:MA, NCC, LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4038 E 53RD ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-4816
Mailing Address - Country:US
Mailing Address - Phone:918-688-0903
Mailing Address - Fax:
Practice Address - Street 1:5200 S YALE AVE STE 400
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7489
Practice Address - Country:US
Practice Address - Phone:918-236-0150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-01
Last Update Date:2023-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011344101YP2500X
OK10674101YP2500X
CO12274101Y00000X
CO325101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)