Provider Demographics
NPI:1790116416
Name:OKEMWA, LYNET
Entity Type:Individual
Prefix:
First Name:LYNET
Middle Name:
Last Name:OKEMWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 NW 194TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-3493
Mailing Address - Country:US
Mailing Address - Phone:405-209-5408
Mailing Address - Fax:
Practice Address - Street 1:202 S WASHITA AVE
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:OK
Practice Address - Zip Code:73098-7820
Practice Address - Country:US
Practice Address - Phone:405-665-4385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation