Healthcare Provider Details

I. General information

NPI: 1205896867
Provider Name (Legal Business Name): LISA M HENDERSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 S YALE AVE LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL
TULSA OK
74136-3326
US

IV. Provider business mailing address

6655 S YALE AVE LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL
TULSA OK
74136-3326
US

V. Phone/Fax

Practice location:
  • Phone: 918-491-3702
  • Fax: 918-491-5740
Mailing address:
  • Phone: 918-491-3702
  • Fax: 918-491-5740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1715
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: