Provider Demographics
NPI:1265753396
Name:PRINCE, KRISTY (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:
Last Name:PRINCE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 NE RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-8210
Mailing Address - Country:US
Mailing Address - Phone:580-512-7502
Mailing Address - Fax:
Practice Address - Street 1:3710 NE RICHMOND ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-8210
Practice Address - Country:US
Practice Address - Phone:580-512-7502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3582101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health