Provider Demographics
NPI:1801178280
Name:HALL, CHRISTY MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:MARIE
Last Name:HALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:MARIA
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:15495 DENTONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-8738
Mailing Address - Country:US
Mailing Address - Phone:918-759-1017
Mailing Address - Fax:
Practice Address - Street 1:15495 DENTONVILLE RD
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-8738
Practice Address - Country:US
Practice Address - Phone:918-759-1017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1041C0700X
1041C0700X
OK62311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200378320BMedicaid
OK1801178280Medicaid