Provider Demographics
NPI:1942257126
Name:GWINN, ELIZABETH E (MS, LPC, LBP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:E
Last Name:GWINN
Suffix:
Gender:F
Credentials:MS, LPC, LBP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E FRANKLIN AVE
Mailing Address - Street 2:#103A
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-5156
Mailing Address - Country:US
Mailing Address - Phone:580-774-2668
Mailing Address - Fax:580-774-2668
Practice Address - Street 1:110 E FRANKLIN AVE
Practice Address - Street 2:#103A
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-5156
Practice Address - Country:US
Practice Address - Phone:580-774-2668
Practice Address - Fax:580-774-2668
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLBP 0242103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling