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NPI Code Detail

MEDICARE: MRS. JENNIFER LYNNE MATHIS-COLLEY L.P.C.

MEDICARE: MRS. JENNIFER LYNNE MATHIS-COLLEY L.P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor1876OK

General Provider Information

NPI Number : 1548368988
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER LYNNE MATHIS-COLLEY L.P.C.
Provider Business Mailing Address
First Line : 13204 S 267TH EAST AVE
Second Line :
City : COWETA
State : OK
Zip : 74429-5864
Country : US
Telephone Number : 918-486-8122
Fax Number :
Provider Business Practice Location Address
First Line : 6216 S LEWIS AVE STE 180
Second Line :
City : TULSA
State : OK
Zip : 74136-1077
Country : US
Telephone Number : 918-960-7852
Fax Number : 539-664-5738
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 03/20/2024

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Directions to “ MRS. JENNIFER LYNNE MATHIS-COLLEY L.P.C.” Practice Location

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