Provider Demographics
NPI:1790163368
Name:COOLEY, KRISTI MICHELLE
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:MICHELLE
Last Name:COOLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 KNOX RD
Mailing Address - Street 2:APT 108
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1069
Mailing Address - Country:US
Mailing Address - Phone:580-277-9900
Mailing Address - Fax:
Practice Address - Street 1:2305 SW H AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-8103
Practice Address - Country:US
Practice Address - Phone:580-669-8551
Practice Address - Fax:580-699-8553
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor