MEDICARE: CEILIDH D IMES LPC-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	13342	OK

General Provider Information

NPI Number	:	1043152747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CEILIDH D IMES LPC-C

Provider Business Mailing Address
First Line	:	1703 N CANARY DR
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-6152
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 S FRETZ AVE
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73003-5570
Country	:	US
Telephone Number	:	580-956-4827
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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