Provider Demographics
NPI:1053342097
Name:EZENWA, DEBBIE ELAINE (LPC)
Entity type:Individual
Prefix:MS
First Name:DEBBIE
Middle Name:ELAINE
Last Name:EZENWA
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 1:1809 E 72ND ST
Mailing Address - Street 2:#1913
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5368
Mailing Address - Country:US
Mailing Address - Phone:918-402-5957
Mailing Address - Fax:
Practice Address - Street 1:5525 E 51ST ST
Practice Address - Street 2:SUITE #400
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7461
Practice Address - Country:US
Practice Address - Phone:918-388-6234
Practice Address - Fax:918-388-6456
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2628101YP2500X, 101YM0800X
MO2021017371101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health