Healthcare Provider Details

I. General information

NPI: 1770854309
Provider Name (Legal Business Name): WYNELL JEAN LLOYD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7565 E US HIGHWAY 66
EL RENO OK
73036-9120
US

IV. Provider business mailing address

PO BOX 1207
EL RENO OK
73036-1207
US

V. Phone/Fax

Practice location:
  • Phone: 405-262-6555
  • Fax: 405-262-6557
Mailing address:
  • Phone: 405-262-6555
  • Fax: 405-262-6557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2784
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: