Individual
DESTINY LYN ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC-S
Contact information
Practice address
8551 N 125TH EAST AVE STE 250, OWASSO, OK 74055-2160
(918) 760-5243
Mailing address
15031 S 4060 RD, OOLOGAH, OK 74053-3737
(918) 728-9516
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
10335
OK
171M00000X
Case Manager/Care Coordinator
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/27/2017
Last updated
04/07/2026
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