Healthcare Provider Details

I. General information

NPI: 1417900341
Provider Name (Legal Business Name): FRANCIS PAUL JETTE SOCIAL WORKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 WILSON STREET RAHC SUDCC
FORT SILL OK
73503-6300
US

IV. Provider business mailing address

1134 NW MAPLE AVE
LAWTON OK
73507-4609
US

V. Phone/Fax

Practice location:
  • Phone: 580-558-8432
  • Fax: 580-442-7950
Mailing address:
  • Phone: 580-678-1070
  • Fax: 580-442-7950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberB21394
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2469
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: