Provider Demographics
NPI:1447823166
Name:HUTTON, CHRISTINA DENISE
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:DENISE
Last Name:HUTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:DENISE
Other - Last Name:SOTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8925 STATE HWY 66
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74131
Mailing Address - Country:US
Mailing Address - Phone:539-549-1839
Mailing Address - Fax:
Practice Address - Street 1:650 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-4429
Practice Address - Country:US
Practice Address - Phone:918-587-9471
Practice Address - Fax:918-860-1399
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 171M00000X
OKLPCCANDIDATE12229101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator