Provider Demographics
NPI:1861273674
Name:LIGHTWORK PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:LIGHTWORK PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LATOSHA
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAMOS LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:785-220-6088
Mailing Address - Street 1:1216 NW 32ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-5607
Mailing Address - Country:US
Mailing Address - Phone:785-220-6088
Mailing Address - Fax:
Practice Address - Street 1:1111 MAGNOLIA CT STE 209
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-1391
Practice Address - Country:US
Practice Address - Phone:405-256-8230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty