Provider Demographics
NPI:1265700868
Name:CANNON, CHRISTINA LEE (BS ELEM ED, BHRS)
Entity type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:LEE
Last Name:CANNON
Suffix:
Gender:F
Credentials:BS ELEM ED, BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8914 E MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74115-5929
Mailing Address - Country:US
Mailing Address - Phone:918-470-7510
Mailing Address - Fax:
Practice Address - Street 1:721 S GEORGE NIGH EXPY
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-7400
Practice Address - Country:US
Practice Address - Phone:918-302-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health