Provider Demographics
NPI:1538112271
Name:SAMPLE, LENORA SUE ANN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LENORA
Middle Name:SUE ANN
Last Name:SAMPLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14310 S 273RD EAST AVE
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429-6536
Mailing Address - Country:US
Mailing Address - Phone:918-279-0017
Mailing Address - Fax:918-279-0017
Practice Address - Street 1:5525 E 51ST ST
Practice Address - Street 2:SUITE #400
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7461
Practice Address - Country:US
Practice Address - Phone:918-388-6269
Practice Address - Fax:918-388-6456
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2915101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional