Provider Demographics
NPI:1972708477
Name:CHRISTOPHER, KIMBERLY ELAINE (MCP, LPC CANDIDATE)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ELAINE
Last Name:CHRISTOPHER
Suffix:
Gender:F
Credentials:MCP, LPC CANDIDATE
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:ELAINE
Other - Last Name:CHRISTOPHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CONTRACT CASE MNGR
Mailing Address - Street 1:605 WEST OXFORD
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-1208
Mailing Address - Country:US
Mailing Address - Phone:580-233-7220
Mailing Address - Fax:580-237-7550
Practice Address - Street 1:605 WEST OXFORD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-1208
Practice Address - Country:US
Practice Address - Phone:580-233-7220
Practice Address - Fax:580-237-7550
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100731500DMedicaid