Provider Demographics
NPI:1427277953
Name:SHALLCROSS, KRISTY LYN (LCSW)
Entity type:Individual
Prefix:MISS
First Name:KRISTY
Middle Name:LYN
Last Name:SHALLCROSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 S CARSON AVE
Mailing Address - Street 2:#218
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119-5001
Mailing Address - Country:US
Mailing Address - Phone:918-520-8470
Mailing Address - Fax:
Practice Address - Street 1:1816 S CARSON AVE
Practice Address - Street 2:#218
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-5001
Practice Address - Country:US
Practice Address - Phone:918-520-8470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX543111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health