Provider Demographics
NPI:1205167707
Name:TRICKETT, LISA DIANE (MS, LPC-US)
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:DIANE
Last Name:TRICKETT
Suffix:
Gender:F
Credentials:MS, LPC-US
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 NW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-1653
Mailing Address - Country:US
Mailing Address - Phone:918-967-8223
Mailing Address - Fax:918-967-8203
Practice Address - Street 1:904 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462
Practice Address - Country:US
Practice Address - Phone:918-967-8223
Practice Address - Fax:918-967-8203
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100746580AMedicaid