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NPI Code Detail

MEDICARE: MRS. ALISA K LITTLE-LONGNECKER LPC

MEDICARE: MRS. ALISA K LITTLE-LONGNECKER LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor2451OK

General Provider Information

NPI Number : 1619945201
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ALISA K LITTLE-LONGNECKER LPC
Provider Business Mailing Address
First Line : 7014 S 235TH EAST AVE
Second Line :
City : BROKEN ARROW
State : OK
Zip : 74014-8121
Country : US
Telephone Number : 918-388-6449
Fax Number :
Provider Business Practice Location Address
First Line : 5525 E 51ST ST
Second Line : SUITE #400
City : TULSA
State : OK
Zip : 74135-7461
Country : US
Telephone Number : 918-388-6449
Fax Number : 918-388-6456
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. ALISA K LITTLE-LONGNECKER LPC” Practice Location

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