Provider Demographics
NPI:1942504808
Name:SCHRADER, KRISTINE ERIKA (MA)
Entity Type:Individual
Prefix:MISS
First Name:KRISTINE
Middle Name:ERIKA
Last Name:SCHRADER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 N OKMULGEE AVE.
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-6534
Mailing Address - Country:US
Mailing Address - Phone:918-756-7700
Mailing Address - Fax:918-756-3347
Practice Address - Street 1:1950 N OKMULGEE AVE.
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6534
Practice Address - Country:US
Practice Address - Phone:918-756-7700
Practice Address - Fax:918-756-3347
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.005728101Y00000X, 101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional