Provider Demographics
NPI:1407976814
Name:RENFROW, EMILY J (LMFT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:J
Last Name:RENFROW
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 202
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-0202
Mailing Address - Country:US
Mailing Address - Phone:918-967-2558
Mailing Address - Fax:
Practice Address - Street 1:20155 N AIRPORT RD
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-2631
Practice Address - Country:US
Practice Address - Phone:918-967-2558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK944106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK20054500BMedicaid