Provider Demographics
NPI:1386386217
Name:MCCRACKEN, CHARLEEN RENE (LPC)
Entity type:Individual
Prefix:MRS
First Name:CHARLEEN
Middle Name:RENE
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CHARLEEN
Other - Middle Name:RENE
Other - Last Name:HAXTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1527 S LEWIS PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5120
Mailing Address - Country:US
Mailing Address - Phone:918-704-4199
Mailing Address - Fax:
Practice Address - Street 1:650 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-4429
Practice Address - Country:US
Practice Address - Phone:918-587-9471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2415101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor