Provider Demographics
NPI:1255735031
Name:MCDONALD, LELIA KATHRYN (LPC)
Entity type:Individual
Prefix:
First Name:LELIA
Middle Name:KATHRYN
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:DR
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:4107 E 98TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4808
Mailing Address - Country:US
Mailing Address - Phone:539-777-1619
Mailing Address - Fax:
Practice Address - Street 1:4527 E 91ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4080
Practice Address - Country:US
Practice Address - Phone:539-777-1619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4821101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional