Healthcare Provider Details

I. General information

NPI: 1336855352
Provider Name (Legal Business Name): JESSICA R HEACOCK-FELIX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 S MAY AVE
OKLAHOMA CITY OK
73170-4502
US

IV. Provider business mailing address

12301 S MAY AVE
OKLAHOMA CITY OK
73170-4502
US

V. Phone/Fax

Practice location:
  • Phone: 405-388-0006
  • Fax:
Mailing address:
  • Phone: 405-388-0006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: