Healthcare Provider Details

I. General information

NPI: 1588548267
Provider Name (Legal Business Name): ANDREW ROSS LORENZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 N WHEELER AVE
SALLISAW OK
74955-2227
US

IV. Provider business mailing address

1108 N WHEELER AVE
SALLISAW OK
74955-2227
US

V. Phone/Fax

Practice location:
  • Phone: 918-775-5513
  • Fax: 918-775-5526
Mailing address:
  • Phone: 918-775-5513
  • Fax: 918-775-5526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: