Healthcare Provider Details

I. General information

NPI: 1720527104
Provider Name (Legal Business Name): JENNIFER LEE GRIFFITH MHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105365 S HIGHWAY 102
MCLOUD OK
74851-3051
US

IV. Provider business mailing address

105365 S HIGHWAY 102
MCLOUD OK
74851-3051
US

V. Phone/Fax

Practice location:
  • Phone: 405-964-2618
  • Fax:
Mailing address:
  • Phone: 405-964-2618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6897
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: