Provider Demographics
NPI:1205545381
Name:ROSSETTI SHEKOUH, KRISTINA GRACE
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:GRACE
Last Name:ROSSETTI SHEKOUH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:SHEKOUH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1900 E 15TH ST STE 800B
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6682
Mailing Address - Country:US
Mailing Address - Phone:405-455-6868
Mailing Address - Fax:405-562-3444
Practice Address - Street 1:1900 E 15TH ST STE B
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6610
Practice Address - Country:US
Practice Address - Phone:405-455-6868
Practice Address - Fax:405-562-3444
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist