Provider Demographics
NPI:1134423064
Name:TRAFFANSTEDT, JOHN CHRISTOPHER (REVEREND; CPLC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CHRISTOPHER
Last Name:TRAFFANSTEDT
Suffix:
Gender:M
Credentials:REVEREND; CPLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 N PEBBLE CREEK TER
Mailing Address - Street 2:APT. 102
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-4234
Mailing Address - Country:US
Mailing Address - Phone:405-628-7250
Mailing Address - Fax:
Practice Address - Street 1:330 N PEBBLE CREEK TER
Practice Address - Street 2:APT. 102
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-4234
Practice Address - Country:US
Practice Address - Phone:405-628-7250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral