Provider Demographics
NPI:1356689368
Name:MCGILL, LEMIKA D
Entity Type:Individual
Prefix:MS
First Name:LEMIKA
Middle Name:D
Last Name:MCGILL
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 1:2734 S 122ND EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-8215
Mailing Address - Country:US
Mailing Address - Phone:918-288-4611
Mailing Address - Fax:
Practice Address - Street 1:2734 S 122ND EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-8215
Practice Address - Country:US
Practice Address - Phone:918-288-4611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103K00000X-BEHAVIORA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst