Provider Demographics
NPI:1508037581
Name:JOHNDROW, LILLIAN KAY (LPC, LBP, LADC)
Entity Type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:KAY
Last Name:JOHNDROW
Suffix:
Gender:F
Credentials:LPC, LBP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 LENAPE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NOWATA
Mailing Address - State:OK
Mailing Address - Zip Code:75048
Mailing Address - Country:US
Mailing Address - Phone:918-273-7504
Mailing Address - Fax:918-273-3451
Practice Address - Street 1:1020 LENAPE DRIVE
Practice Address - Street 2:
Practice Address - City:NOWATA
Practice Address - State:OK
Practice Address - Zip Code:75048
Practice Address - Country:US
Practice Address - Phone:918-273-7504
Practice Address - Fax:918-273-3451
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK554101YA0400X
OK14101YM0800X
OK1939101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health