Provider Demographics
NPI:1093063836
Name:AYALA, ELIZABETH
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:
Last Name:AYALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 SW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-7305
Mailing Address - Country:US
Mailing Address - Phone:580-581-1818
Mailing Address - Fax:
Practice Address - Street 1:1719 SW 11TH ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-7305
Practice Address - Country:US
Practice Address - Phone:580-581-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No171M00000XOther Service ProvidersCase Manager/Care Coordinator