Provider Demographics
NPI:1902198013
Name:ROSENQUIST, ERIC PAUL CHRISTIAN (MS, LPC, LBP)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:PAUL CHRISTIAN
Last Name:ROSENQUIST
Suffix:
Gender:M
Credentials:MS, LPC, LBP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 W E AVE
Mailing Address - Street 2:
Mailing Address - City:CACHE
Mailing Address - State:OK
Mailing Address - Zip Code:73527-9434
Mailing Address - Country:US
Mailing Address - Phone:580-429-9870
Mailing Address - Fax:
Practice Address - Street 1:1204 W E AVE
Practice Address - Street 2:
Practice Address - City:CACHE
Practice Address - State:OK
Practice Address - Zip Code:73527-9434
Practice Address - Country:US
Practice Address - Phone:580-429-9870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-07
Last Update Date:2011-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0109101YM0800X
OK2757101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health