Healthcare Provider Details

I. General information

NPI: 1710243829
Provider Name (Legal Business Name): JESSICA RHEA STEELMAN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 HARBOR RD
GROVE OK
74344-3505
US

IV. Provider business mailing address

303 BLUNT AVE APT 1
PRAIRIE GROVE AR
72753-3142
US

V. Phone/Fax

Practice location:
  • Phone: 479-524-0477
  • Fax:
Mailing address:
  • Phone: 918-413-4515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC CANIDATE
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: