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General NPI Number Information
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NPI Number | 1376656850
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Entity Type | Individual
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Provider Name | LISA M. WHERTVINE M.S.,LPC
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Gender | Female
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 301 W MAIN ST STE 324
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City | ARDMORE
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State | OK
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Zip | 73401-6322
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Country | US
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Telephone | 580-226-9222
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Fax | 580-226-9226
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Provider Business Mailing Address
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Address Line | 301 W MAIN ST STE 324
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City | ARDMORE
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State | OK
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Zip | 73401-6322
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Country | US
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Telephone | 580-226-9222
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Fax | 580-226-9226
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1777
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License Number State | OK
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