Provider Demographics
NPI:1942929765
Name:SPARROW, CHRISTOPHER ALLAN (STUDENT PROVIDER)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ALLAN
Last Name:SPARROW
Suffix:
Gender:M
Credentials:STUDENT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 N MAIN ST STE M12
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-3149
Mailing Address - Country:US
Mailing Address - Phone:580-379-0677
Mailing Address - Fax:580-482-0008
Practice Address - Street 1:1116 N MAIN ST STE M12
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-3149
Practice Address - Country:US
Practice Address - Phone:580-379-0677
Practice Address - Fax:580-482-0008
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKSTUDENT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health