Provider Demographics
NPI:1205549441
Name:BENDER, ELAINE (MS, LPC, NCC)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:BENDER
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 E 130TH PL S
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-4446
Mailing Address - Country:US
Mailing Address - Phone:505-516-5553
Mailing Address - Fax:
Practice Address - Street 1:3124 E APACHE ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74110-2320
Practice Address - Country:US
Practice Address - Phone:918-743-5673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10971101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health