Healthcare Provider Details

I. General information

NPI: 1194323550
Provider Name (Legal Business Name): JENNIFER NICOLE BRONSON MA. LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2529 S KELLEY AVE SUITE C
EDMOND OK
73013
US

IV. Provider business mailing address

2529 S KELLEY AVE SUITE C
EDMOND OK
73013
US

V. Phone/Fax

Practice location:
  • Phone: 405-615-4860
  • Fax:
Mailing address:
  • Phone: 405-615-4860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11299
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: