Provider Demographics
NPI:1356426381
Name:WILSON, KRISTIN LEEAN (LPC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEEAN
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S JOHNSTONE AVE
Mailing Address - Street 2:SUITE 503
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-6622
Mailing Address - Country:US
Mailing Address - Phone:918-337-6050
Mailing Address - Fax:918-337-6061
Practice Address - Street 1:501 S JOHNSTONE AVE
Practice Address - Street 2:SUITE 503
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-6622
Practice Address - Country:US
Practice Address - Phone:918-337-6050
Practice Address - Fax:918-337-6061
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3199101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional