Healthcare Provider Details

I. General information

NPI: 1497664155
Provider Name (Legal Business Name): TINA LOIUSE KING LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 NW 23RD ST
OKLAHOMA CITY OK
73107-2000
US

IV. Provider business mailing address

23100 N BRIARWOOD DR
EDMOND OK
73025-9503
US

V. Phone/Fax

Practice location:
  • Phone: 405-445-4640
  • Fax:
Mailing address:
  • Phone: 405-820-1068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC02387
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: