Organization
KRYSTAL EASTER MS, LPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRYSTAL NICHOLE VASQUEZ LPC (OWNER/THERAPIST)
(479) 659-2288
Entity
Organization
Contact information
Practice address
2201 OAKRIDGE DR, TAHLEQUAH, OK 74464
(918) 216-9664
Mailing address
2201 OAKRIDGE DR, TAHLEQUAH, OK 74464
(479) 659-2288
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6089
OK
Other
Enumeration date
03/15/2017
Last updated
07/21/2020
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