MEDICARE: MRS. LAURA CHRISTINE BALLIETT-BOX 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
1	101YP2500X	Professional Counselor	1397	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1397	OTHER	OK	LPC

General Provider Information

NPI Number	:	1780776153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA CHRISTINE BALLIETT-BOX LPC

Provider Business Mailing Address
First Line	:	301 NW 63RD ST STE 650
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-7915
Country	:	US
Telephone Number	:	405-607-1717
Fax Number	:	405-635-8417

Provider Business Practice Location Address
First Line	:	2701 S HARVEY AVE FL 2
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-6726
Country	:	US
Telephone Number	:	405-636-1463
Fax Number	:	405-635-8417

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	04/05/2026

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