Healthcare Provider Details

I. General information

NPI: 1154645406
Provider Name (Legal Business Name): JILL ELIZABETH DAVIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 ALAMEDA ST
NORMAN OK
73071-5229
US

IV. Provider business mailing address

PO BOX 400
NORMAN OK
73070-0400
US

V. Phone/Fax

Practice location:
  • Phone: 405-360-5100
  • Fax:
Mailing address:
  • Phone: 405-573-6480
  • Fax: 405-573-3806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4140
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: