Healthcare Provider Details

I. General information

NPI: 1982996369
Provider Name (Legal Business Name): JENNIFER DORRIS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6922 S WESTERN AVE SUITE 101
OKLAHOMA CITY OK
73139-1803
US

IV. Provider business mailing address

6922 S WESTERN AVE SUITE 101
OKLAHOMA CITY OK
73139-1803
US

V. Phone/Fax

Practice location:
  • Phone: 405-632-2815
  • Fax:
Mailing address:
  • Phone: 405-632-2815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2569
License Number StateOK

VIII. Authorized Official

Name: MRS. JENNIFER F DORRIS
Title or Position: PRESIDENT
Credential: MS, LPC
Phone: 405-520-1461