Provider Demographics
NPI:1396177473
Name:ACOSTA DE WILLIS, CLARA ELENA (LPC)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:ELENA
Last Name:ACOSTA DE WILLIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 S 100TH EAST AVE
Mailing Address - Street 2:SUITE 200-C
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-3650
Mailing Address - Country:US
Mailing Address - Phone:918-813-2354
Mailing Address - Fax:
Practice Address - Street 1:4150 S 100TH EAST AVE
Practice Address - Street 2:SUITE 200-C
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-3650
Practice Address - Country:US
Practice Address - Phone:918-813-2354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5056101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional