MEDICARE: LYDIA CUDJOE

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		OK

General Provider Information

NPI Number	:	1669795126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA CUDJOE

Provider Business Mailing Address
First Line	:	2220 N. CLASSEN
Second Line	:	SUITE E
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106
Country	:	US
Telephone Number	:	405-528-1748
Fax Number	:

Provider Business Practice Location Address
First Line	:	6900 N. KELLEY AVENUE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111
Country	:	US
Telephone Number	:	405-478-0781
Fax Number	:

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

Provider Enumeration Date	:	03/11/2010
Last Update Date	:	03/11/2010

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Directions to “ LYDIA CUDJOE ” Practice Location

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