Healthcare Provider Details

I. General information

NPI: 1427517754
Provider Name (Legal Business Name): LISA DOVER MSPS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2019
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S WASHITA AVE
WYNNEWOOD OK
73098-7820
US

IV. Provider business mailing address

202 S WASHITA AVE
WYNNEWOOD OK
73098-7820
US

V. Phone/Fax

Practice location:
  • Phone: 918-861-7652
  • Fax:
Mailing address:
  • Phone: 918-861-7652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11601
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: