Provider Demographics
NPI:1730281874
Name:CHRISTENSEN, DARIS LAVERNE (MED LPC)
Entity Type:Individual
Prefix:MS
First Name:DARIS
Middle Name:LAVERNE
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:MISS
Other - First Name:DARIS
Other - Middle Name:LAVERNE
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED LPC
Mailing Address - Street 1:PO BOX 585
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096
Mailing Address - Country:US
Mailing Address - Phone:580-772-2899
Mailing Address - Fax:580-772-2585
Practice Address - Street 1:110 FRANKLIN ST
Practice Address - Street 2:SUITE 104A
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096
Practice Address - Country:US
Practice Address - Phone:580-772-2899
Practice Address - Fax:580-772-2585
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2862101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional