Provider Demographics
NPI:1538886585
Name:LUJAN, MARY ELAINE (MA, LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELAINE
Last Name:LUJAN
Suffix:
Gender:
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 SE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-8136
Mailing Address - Country:US
Mailing Address - Phone:405-204-7062
Mailing Address - Fax:
Practice Address - Street 1:3311 W ROCK CREEK RD STE 110
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2455
Practice Address - Country:US
Practice Address - Phone:405-300-5730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11087101YP2500X
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor