Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | ||
Y | 101YP2500X | Professional Counselor | 4663 | OK |
NPI | 1104157593 |
---|---|
Provider Name | Dane Lee Lemmons |
First Address | Oklahoma City, OK 73105 |
Second Address | Oklahoma City, OK 73105-2832 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2010 |
Last Update Date | 13/05/2013 |