Individual ProviderKrystal Dawn HaltomCounselorBehavioral Health & Social Service ProvidersPractice Address6801 S Western Ave Ste 101, Oklahoma City, OK 73139-1816(405) 550-2688PECOS EnrollmentBased on the most recent information from CMS, provider Krystal Dawn Haltom does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1265751960Provider TypeIndividualFull NameHaltom, Krystal DawnTitleMissCredentialM.A, LPCGenderFemaleSole ProprietorYesEnumeration Date5/20/2010Last Updated2/24/2026Contact InformationPractice LocationPractice Address6801 S Western Ave Ste 101, Oklahoma City, OK 73139-1816Phone(405) 550-2688Fax(405) 619-3924Mailing LocationMailing Address6801 S Western Ave Ste 101, Oklahoma City, OK 73139-1816Phone(405) 550-2688Fax(405) 619-3924Provider TaxonomiesCodeDescriptionLicenseCode101YP2500XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicense6323OklahomaProvider IdentifiersIDDescriptionIssuerID200375440BDescriptionMedicaidIssuerUnlistedOklahomaID82-0996935DescriptionOtherIssuerDEPARTMENT OF THE TREASURY INTERNAL REVENUE SERVICEOklahomaID1164939765DescriptionOtherIssuerWORK NPIOklahoma