Provider Demographics
NPI:1427656909
Name:LASHONDA MOBLEY WAITERS, LPC
Entity type:Organization
Organization Name:LASHONDA MOBLEY WAITERS, LPC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LASHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:405-625-3168
Mailing Address - Street 1:2701 NW 185TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-9795
Mailing Address - Country:US
Mailing Address - Phone:405-625-3168
Mailing Address - Fax:
Practice Address - Street 1:2701 NW 185TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-9795
Practice Address - Country:US
Practice Address - Phone:405-625-3168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK6000OtherOKSLB