Provider Demographics
NPI:1629314208
Name:AINSWORTH, CARLA KAY (LPC)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:KAY
Last Name:AINSWORTH
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 1:2001 S COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-5689
Mailing Address - Country:US
Mailing Address - Phone:940-886-8677
Mailing Address - Fax:
Practice Address - Street 1:2001 S COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-5689
Practice Address - Country:US
Practice Address - Phone:940-886-8677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-30
Last Update Date:2012-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4946101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional