Healthcare Provider Details

I. General information

NPI: 1063081453
Provider Name (Legal Business Name): JILL LEANN GARRISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 S VIRGINIA AVE
BARTLESVILLE OK
74003-4439
US

IV. Provider business mailing address

700 S PENN AVE
BARTLESVILLE OK
74003-3847
US

V. Phone/Fax

Practice location:
  • Phone: 918-337-8080
  • Fax: 918-337-8099
Mailing address:
  • Phone: 918-337-8080
  • Fax: 918-337-8099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCCANDIDATE12541
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: