Provider Demographics
NPI:1639373954
Name:TODD, LISA NICHOLE (BS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:NICHOLE
Last Name:TODD
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:NICHOLE
Other - Last Name:HUGHSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:403 ASH ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1720
Mailing Address - Country:US
Mailing Address - Phone:580-223-5636
Mailing Address - Fax:580-226-6727
Practice Address - Street 1:2530 S COMMERCE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-0189
Practice Address - Country:US
Practice Address - Phone:580-223-5636
Practice Address - Fax:580-226-6727
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health