Healthcare Provider Details

I. General information

NPI: 1164875712
Provider Name (Legal Business Name): JESSICA LYNN HERNING MHR, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 S EASTERN AVE
MOORE OK
73160-5942
US

IV. Provider business mailing address

3184 ROCK CREEK TRL APT 1103
NORMAN OK
73072-2524
US

V. Phone/Fax

Practice location:
  • Phone: 405-794-1591
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6950
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: