| Lillian Mae, Llc | |
|
44038 45th St Shawnee OK 74804-9683 | |
| (405) 219-0030 | |
| (405) 730-5169 |
| Full Name | Lillian Mae, Llc |
|---|---|
| Speciality | Counselor |
| Location | 44038 45th St, Shawnee, Oklahoma |
| Authorized Official Name and Position | Amy A. Jennings (LICENSED PROFESSIONAL COUNSELOR) |
| Authorized Official Contact | 4052190030 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lillian Mae, Llc 6 Turkey Knob St Shawnee OK 74804-3231 Ph: (405) 219-0030 | Lillian Mae, Llc 44038 45th St Shawnee OK 74804-9683 Ph: (405) 219-0030 |
| NPI Number | 1700489176 |
|---|---|
| Provider Enumeration Date | 11/18/2020 |
| Last Update Date | 11/18/2020 |
| Certification Date | 11/18/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700489176 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
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