Provider Demographics
NPI:1457663874
Name:KYGAR, KRIS DERYLE (LADC MH)
Entity type:Individual
Prefix:MR
First Name:KRIS
Middle Name:DERYLE
Last Name:KYGAR
Suffix:
Gender:M
Credentials:LADC MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6608 N WESTERN AVE # 1562
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7326
Mailing Address - Country:US
Mailing Address - Phone:405-256-8102
Mailing Address - Fax:
Practice Address - Street 1:9531 E CARDINAL PL # 1562
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-2518
Practice Address - Country:US
Practice Address - Phone:405-256-8102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1441101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor