Organization
LILLIAN MAE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY A. JENNINGS M.S., LPC (LICENSED PROFESSIONAL COUNSELOR)
(405) 219-0030
Entity
Organization
Contact information
Practice address
44038 45TH ST, SHAWNEE, OK 74804-9683
(405) 219-0030
(405) 730-5169
Mailing address
6 TURKEY KNOB ST, SHAWNEE, OK 74804-3231
(405) 219-0030
(405) 730-5169
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
11/18/2020
Last updated
11/18/2020
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