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General NPI Number Information
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NPI Number | 1366205957
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Entity Type | Organization
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Legal Business Name | LISA IRWIN, LLC
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Dates
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Enumeration Date | 02/05/2024
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 112 N JACKSON ST
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City | ENID
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State | OK
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Zip | 73701-3848
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Country | US
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Telephone | 580-254-1535
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Fax | 580-237-1947
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Provider Business Mailing Address
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Address Line | 112 N JACKSON ST
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City | ENID
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State | OK
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Zip | 73701-3848
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Country | US
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Telephone | 580-254-1535
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Fax | 580-237-1947
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | MRS. LISA IRWIN
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Credential | LPC
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Telephone | 580-254-1535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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