Provider Demographics
NPI:1871554600
Name:CANNIDA, LORI CHRIS (LPC)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:CHRIS
Last Name:CANNIDA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11501 E 102ND ST N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-6675
Mailing Address - Country:US
Mailing Address - Phone:918-344-7551
Mailing Address - Fax:918-344-7551
Practice Address - Street 1:5272 S LEWIS AVE
Practice Address - Street 2:240
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6544
Practice Address - Country:US
Practice Address - Phone:918-344-7551
Practice Address - Fax:918-344-7551
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3291101YM0800X
OK5261101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1383WOtherBLUE CROSS BLUE SHIELD
NC6102224Medicaid