Provider Demographics
NPI:1760768949
Name:RICHARDS, CHRISTOPHER KEVIN II
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:KEVIN
Last Name:RICHARDS
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 W WILSHIRE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7777
Mailing Address - Country:US
Mailing Address - Phone:405-286-3373
Mailing Address - Fax:
Practice Address - Street 1:433 W WILSHIRE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7777
Practice Address - Country:US
Practice Address - Phone:405-286-3373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)