Provider Demographics
NPI:1770854309
Name:LLOYD, WYNELL JEAN (LPC)
Entity Type:Individual
Prefix:
First Name:WYNELL
Middle Name:JEAN
Last Name:LLOYD
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 1207
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-1207
Mailing Address - Country:US
Mailing Address - Phone:405-262-6555
Mailing Address - Fax:405-262-6557
Practice Address - Street 1:7565 E US HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-9120
Practice Address - Country:US
Practice Address - Phone:405-262-6555
Practice Address - Fax:405-262-6557
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2784101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100731420AMedicaid