Healthcare Provider Details

I. General information

NPI: 1205259744
Provider Name (Legal Business Name): LAWRENCE ADEMILUYI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 N CLASSEN BLVD STE 159
OKLAHOMA CITY OK
73118-4618
US

IV. Provider business mailing address

10048 MILLSPAUGH WAY
YUKON OK
73099-7976
US

V. Phone/Fax

Practice location:
  • Phone: 405-607-6670
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: