Provider Demographics
NPI:1508088998
Name:WADSWORTH, DEBRA LYNNELLE (LPC)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:LYNNELLE
Last Name:WADSWORTH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:DEBRA
Other - Middle Name:LYNNELLE
Other - Last Name:LEACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 S DEWEY AVE SUITE 108
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003
Mailing Address - Country:US
Mailing Address - Phone:918-336-0810
Mailing Address - Fax:918-257-4247
Practice Address - Street 1:401 S DEWEY AVE SUITE 108
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003
Practice Address - Country:US
Practice Address - Phone:918-257-4244
Practice Address - Fax:918-257-4247
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4555101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health