Provider Demographics
NPI:1912381500
Name:SPENCER, CRISTY
Entity Type:Individual
Prefix:
First Name:CRISTY
Middle Name:
Last Name:SPENCER
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 1:11032 QUAIL CREEK RD
Mailing Address - Street 2:SUITE 265
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-6219
Mailing Address - Country:US
Mailing Address - Phone:405-412-8453
Mailing Address - Fax:405-582-2931
Practice Address - Street 1:9013 NW 79TH TER
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-8820
Practice Address - Country:US
Practice Address - Phone:405-412-8453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional