Basic Information
| Provider Information | |||||||||
| NPI: | 1922433481 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEA | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | LPC, MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5224 SPINNAKER PT | ||||||||
| Address2: | |||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730138650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413372486 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 107 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | KINGFISHER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 737502730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054247711 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2013 | ||||||||
| LastUpdateDate: | 03/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | R3084 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.