Provider Demographics
NPI:1659513943
Name:FITZGIBBON, DONNA JEAN (LPC)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:JEAN
Last Name:FITZGIBBON
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:PO BOX 876
Mailing Address - Street 2:58150 E. 66TH ROAD
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74355-0876
Mailing Address - Country:US
Mailing Address - Phone:918-542-1786
Mailing Address - Fax:918-542-3052
Practice Address - Street 1:58150 E 66 RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6509
Practice Address - Country:US
Practice Address - Phone:918-542-1786
Practice Address - Fax:918-542-3052
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3236101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor