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General NPI Number Information
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NPI Number | 1457651879
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Entity Type | Organization
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Legal Business Name | LANE-HICKS COUNSELING & ART THERAPY CTR PC
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Dates
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Enumeration Date | 11/01/2010
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Last Update Date | 11/01/2010
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Provider Practice Location Address
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Address Line | 1716 WALNUT COVE RD
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City | EDMOND
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State | OK
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Zip | 73013-7663
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Country | US
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Telephone | 405-503-2791
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Fax |
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Provider Business Mailing Address
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Address Line | 1725 E 15TH ST
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City | EDMOND
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State | OK
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Zip | 73013-6602
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Country | US
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Telephone | 405-503-2791
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MS. STEPHANIE M. LANE-HICKS
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Credential | LPC, ATR-BC
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Telephone | 405-503-2791
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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 | 3774
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License Number State | OK
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