Provider Demographics
NPI:1750483814
Name:GINKENS, ALICE LEE (LPC LADC NCC)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:LEE
Last Name:GINKENS
Suffix:
Gender:F
Credentials:LPC LADC NCC
Other - Prefix:
Other - First Name:SHING CHIN
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3312 BRIGHTON PLACE
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099
Mailing Address - Country:US
Mailing Address - Phone:405-410-6871
Mailing Address - Fax:405-601-3317
Practice Address - Street 1:1330 N CLASSEN
Practice Address - Street 2:314
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106
Practice Address - Country:US
Practice Address - Phone:405-601-2307
Practice Address - Fax:405-601-3317
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADC571101YA0400X
OKLPC3515101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health