Healthcare Provider Details

I. General information

NPI: 1477749331
Provider Name (Legal Business Name): AIMEE JOYCE WORTHAM LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 NW FORT SILL BLVD
LAWTON OK
73507-5498
US

IV. Provider business mailing address

753 NW FORT SILL BLVD
LAWTON OK
73507-5498
US

V. Phone/Fax

Practice location:
  • Phone: 580-357-6900
  • Fax: 580-585-6319
Mailing address:
  • Phone: 580-357-6900
  • Fax: 580-585-6319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC 2812
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: