Provider Demographics
NPI:1881004406
Name:CROISSANT, CECILIE
Entity Type:Individual
Prefix:
First Name:CECILIE
Middle Name:
Last Name:CROISSANT
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:P.O. BOX 580700
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74158
Mailing Address - Country:US
Mailing Address - Phone:918-430-0975
Mailing Address - Fax:918-430-0995
Practice Address - Street 1:2442 MOHAWK BLVD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74110
Practice Address - Country:US
Practice Address - Phone:918-430-0975
Practice Address - Fax:918-430-0995
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional