Provider Demographics
NPI:1386131472
Name:CUNNINGHAM, ASHLEE LAUREN (LPC)
Entity type:Individual
Prefix:
First Name:ASHLEE
Middle Name:LAUREN
Last Name:CUNNINGHAM
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 177
Mailing Address - Street 2:
Mailing Address - City:SEILING
Mailing Address - State:OK
Mailing Address - Zip Code:73663-0177
Mailing Address - Country:US
Mailing Address - Phone:580-922-5656
Mailing Address - Fax:580-922-3261
Practice Address - Street 1:423 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-3839
Practice Address - Country:US
Practice Address - Phone:580-922-5656
Practice Address - Fax:580-922-3261
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11868101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200617120AMedicaid