Basic Information
| Provider Information | |||||||||
| NPI: | 1902118235 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | MARILEE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 580700 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741580700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184300975 | ||||||||
| FaxNumber: | 9184300995 | ||||||||
| Practice Location | |||||||||
| Address1: | 2442 MOHAWK BLVD | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184300975 | ||||||||
| FaxNumber: | 9184300995 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2010 | ||||||||
| LastUpdateDate: | 03/10/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 5070 | OK | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.