Provider Demographics
NPI:1376955484
Name:HILL, ELIZABBETH
Entity Type:Individual
Prefix:
First Name:ELIZABBETH
Middle Name:
Last Name:HILL
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 1:715 W MAIN ST
Mailing Address - Street 2:H
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3554
Mailing Address - Country:US
Mailing Address - Phone:918-995-2233
Mailing Address - Fax:918-995-2239
Practice Address - Street 1:715 W MAIN ST
Practice Address - Street 2:H
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3554
Practice Address - Country:US
Practice Address - Phone:918-995-2233
Practice Address - Fax:918-995-2239
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5302101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health