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Individual
LAWRENCE EUGENE ELLIS
Active
Individual
LAWRENCE EUGENE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
366
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1
INSURE OKLAHOMA
OK
01
—
10
INSURE OKLAHOMA
OK
Enumeration date
01/26/2009
Last updated
01/26/2009
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