Provider Demographics
NPI:1477749331
Name:WORTHAM, AIIMEE JOYCE (LPC)
Entity type:Individual
Prefix:
First Name:AIIMEE
Middle Name:JOYCE
Last Name:WORTHAM
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:PO BOX 1603
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73534-1603
Mailing Address - Country:US
Mailing Address - Phone:580-255-8800
Mailing Address - Fax:580-255-8842
Practice Address - Street 1:16 S 7TH ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-4940
Practice Address - Country:US
Practice Address - Phone:580-255-8800
Practice Address - Fax:580-255-8842
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLPC 2812101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health