Individual
AMY RAE LIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4400 N LINCOLN BLVD, OKLAHOMA CITY, OK 73105-5108
(405) 424-7711
Mailing address
8417 BLACKBERRY RDG, EDMOND, OK 73034-2008
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
163W00000X
Registered Nurse
Primary
221832
OK
Other
Enumeration date
12/10/2015
Last updated
03/19/2025
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