Provider Demographics
NPI:1396084968
Name:WELLINGTON, ALICE JANINE (PHD)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:JANINE
Last Name:WELLINGTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SLEEPY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-7431
Mailing Address - Country:US
Mailing Address - Phone:405-474-4151
Mailing Address - Fax:405-330-2938
Practice Address - Street 1:1900 SLEEPY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-7431
Practice Address - Country:US
Practice Address - Phone:405-474-4151
Practice Address - Fax:405-330-2938
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-02
Last Update Date:2013-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK610103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical