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General NPI Number Information
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NPI Number | 1932663283
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Entity Type | Organization
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Legal Business Name | ANNALISA GWIN-VINSANT, LPC, PLLC
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Dates
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Enumeration Date | 01/30/2019
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Last Update Date | 01/30/2019
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Provider Practice Location Address
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Address Line | 8596 E 101ST ST STE D
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City | TULSA
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State | OK
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Zip | 74133-7037
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Country | US
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Telephone | 918-760-2464
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Fax | 918-364-5004
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Provider Business Mailing Address
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Address Line | 5312 E 28TH ST
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City | TULSA
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State | OK
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Zip | 74114-6302
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Country | US
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Telephone | 918-760-2464
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Fax | 918-364-5004
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | ANNALISA GWIN-VINSANT
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Credential | LPC
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Telephone | 918-760-2464
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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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