Healthcare Provider Details

I. General information

NPI: 1891993390
Provider Name (Legal Business Name): LORI DAWN GONZALEZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. LORI DAWN AERY

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3124 E APACHE ST STE 100
TULSA OK
74110-2320
US

IV. Provider business mailing address

3124 E APACHE ST
TULSA OK
74110-2320
US

V. Phone/Fax

Practice location:
  • Phone: 918-508-2755
  • Fax: 918-744-4432
Mailing address:
  • Phone: 918-508-2755
  • Fax: 918-744-4432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3679
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: