Provider Demographics
NPI:1700490570
Name:MOLLOY, KRISTEN RENEE (LPC)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:RENEE
Last Name:MOLLOY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:RENEE
Other - Last Name:MANSEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4400 N LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-5108
Mailing Address - Country:US
Mailing Address - Phone:580-730-0482
Mailing Address - Fax:
Practice Address - Street 1:4202 SW LEE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-8300
Practice Address - Country:US
Practice Address - Phone:580-730-0482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK7676101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program