Healthcare Provider Details

I. General information

NPI: 1285918045
Provider Name (Legal Business Name): JANNA MICHELLE STORER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 N 31ST ST
CLINTON OK
73601-9116
US

IV. Provider business mailing address

2317 MORGANDEE LN
WEATHERFORD OK
73096-2927
US

V. Phone/Fax

Practice location:
  • Phone: 580-323-6021
  • Fax:
Mailing address:
  • Phone: 918-639-1428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: