Healthcare Provider Details

I. General information

NPI: 1174826333
Provider Name (Legal Business Name): LISA JANER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S PENN AVE
BARTLESVILLE OK
74003-3847
US

IV. Provider business mailing address

700 SW PENN AVENUE
BARTLESVILLE OK
74003-3917
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 TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1629
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: