Provider Demographics
NPI:1922375088
Name:POLZIN, CHRISTOPHER DALE (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DALE
Last Name:POLZIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 E 90TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-3367
Mailing Address - Country:US
Mailing Address - Phone:580-231-2440
Mailing Address - Fax:
Practice Address - Street 1:2488 E 81ST ST STE 4805
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4290
Practice Address - Country:US
Practice Address - Phone:918-284-4715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7348101YP2500X
MO2022029311101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional