Provider Demographics
NPI:1558903401
Name:MAI, ELIZABETH A (LPC-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:MAI
Suffix:
Gender:F
Credentials:LPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 E MELTON DR
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:OK
Mailing Address - Zip Code:74346-2704
Mailing Address - Country:US
Mailing Address - Phone:918-253-1700
Mailing Address - Fax:918-253-4938
Practice Address - Street 1:859 E MELTON DR
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:OK
Practice Address - Zip Code:74346-2704
Practice Address - Country:US
Practice Address - Phone:918-253-1700
Practice Address - Fax:918-253-4938
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11653101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional