Provider Demographics
NPI:1396889929
Name:MALVEAUX, KRISTAL ROSE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTAL
Middle Name:ROSE
Last Name:MALVEAUX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KRISTAL
Other - Middle Name:ROSE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:3171 S 129TH EAST AVE
Mailing Address - Street 2:SUITE A PMB 2054
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74134-3215
Mailing Address - Country:US
Mailing Address - Phone:918-960-0207
Mailing Address - Fax:
Practice Address - Street 1:4502 E 41ST STREET
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135
Practice Address - Country:US
Practice Address - Phone:918-960-0207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK63611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical