1538112271 NPI number — MRS. LENORA SUE ANN SAMPLE LPC

Table of content: MRS. LENORA SUE ANN SAMPLE LPC (NPI 1538112271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538112271 NPI number — MRS. LENORA SUE ANN SAMPLE LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAMPLE
Provider First Name:
LENORA
Provider Middle Name:
SUE ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538112271
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14310 S 273RD EAST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COWETA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74429-6536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-279-0017
Provider Business Mailing Address Fax Number:
918-279-0017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5525 E 51ST ST
Provider Second Line Business Practice Location Address:
SUITE #400
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74135-7461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-388-6269
Provider Business Practice Location Address Fax Number:
918-388-6456
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  2915 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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