MEDICARE: MRS. LISA IRWIN M.S., LPC

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	101Y00000X	Counselor	4078	OK
2	101YP2500X	Professional Counselor	4078	OK

General Provider Information

NPI Number	:	1316265911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA IRWIN M.S., LPC

Provider Business Mailing Address
First Line	:	112 N JACKSON ST
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73701-3848
Country	:	US
Telephone Number	:	580-254-1535
Fax Number	:	580-237-1947

Provider Business Practice Location Address
First Line	:	112 N JACKSON ST
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73701-3848
Country	:	US
Telephone Number	:	580-254-1535
Fax Number	:	580-237-1947

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

Provider Enumeration Date	:	05/07/2010
Last Update Date	:	02/05/2024

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